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u. s. 

NAVY 



Medicine 




May 1974 



UNITED STATES NAVY MEDICINE 



Voi. 63 



May 1974 



No. 5 



Vice Admiral D. L. Custis MC USN 
Surgeon General 



Rear Admiral H. S. Etter MC USN 
Deputy Surgeon General 



Captain M. T. Lynch MC USN, Editor 
Mrs. Virginia M. Novinski, Assistant Editor 
Sylvia W. Shaffer, Managing Editor 
Mrs. S. B. Hannan, Graphic Arts 

Contributing Editors 

Psychiatry . . . CAPT R.E. Strange MC USN 
Nurse Corps . . . CAPT E.M. Pfeffer IMC USN 
Legal . . . LCDR J.W. Kercheval II, JAGC USN 
Fleet Support . . . CAPT J.W. Johnson MC USN 
Naval Reserve . . . CAPT W.A. Johnson MC USN 
Dental Corps . . . CAPT R.H. Howard DC USN 
Head and Neck . . . CAPT R.W. Cantrell MC USN 
Gastroenterology . . . CAPT D.O. Castell MC USN 
Research Medicine . . . CAPT C.E. Brodine MC USN 
Submarine Medicine . . . CAPT J.H. Baker MC USN 
Radiation Medicine . . . CAPT J.H. Dowling MSC USN 
Marine Corps Medicine . . . CAPT D.R. Hauler MC USN 
Preventive Medicine . . . CAPT C.E. Alexander MC USN 
Aerospace Medicine . . . CAPT F.H. Austin, Jr. MC USN 
Occupational Medicine . . . CAPT G.M. Lawton MC USN 
Medical Service Corps . . . LCDR F.E. Bennett MSC USN 



POLICY 

U.S. NAVY MEDICINE is basically an official Medical 
Department publication inviting the attention of officers 
of the Medical Department of the Regular Navy and 
Naval Reserve to timely up-to-date items of official and 
professional interest relative to medicine, dentistry and 
allied sciences. The items used are neither intended to be, 
nor are they, susceptible to use by any officer as a substi- 
tute for any item or article, in its original form. The opin- 
ions and conclusions expressed in the articles or items in- 
cluded herein are those of the respective authors and do 
not necessarily represent the views of the Department 
of the Navy, the Bureau of Medicine and Surgery or any 
other governmental department or agency thereof. 



DISTRIBUTION 

U.S. NAVY MEDICINE is distributed to active duty 
Medical Dept. officers via the Standard Navy Distribu- 
tion List {SNDL) vice personal addresses. Requests to 
increase/decrease the number of allotted copies are 
forwarded via the local command to U.S. NAVY 
MEDICINE, Code 1 8, Bureau of Medicine and Surgery, 
Washington, D.C. 20372. 

Retired and Reserve officers on inactive duty may 
subscribe by forwarding request with full name, rank, 
corps, status, address and zip code. 

Notification of address changes should be forwarded 
together with a recent mailing label. 

See inside back cover for additional information. 



The issuance of this publication approved in accordance with MAVEXOS P-35. 



NAVMED P-5088 



CONTENTS 



FROM THE CHIEF 2 

ANNIVERSARY GREETINGS FROM 

DIRECTOR, NAVY NURSE CORPS 4 

FEATURE ARTICLES 

If They Could See Us Now — 

Navy Nurse Corps 1908-1974 5 

Ambulatory-Care Nurse Practitioner Program 10 

CDR A.G. Liakos, NC, USN 

Pediatric Weight Control: Fun and Games 14 

LCDR P. Barkus, NC, USN, 
Mrs. C. Brach, MA and 
LTB. Starr, MSC, USNR 
Career Planning for Medical Officers 

in the Naval Reserve 17 

CAPT K.E. McDonald, MC, USNR-R 
Pediatric Hospitalization and Integrity 

of the Family Unit 20 

LT R.E. Peterson, NC, USNR 
Medical Student Recruiting: Past, 

Present and Future 37 

CAPT M. Backer, MC, USNR 
National Volunteer Week 42 

PROFESSIONAL PAPERS 

The Craniotomy Check Sheet: A Graph-Form 

Index of Clinical Evolution 23 

LCDR L.H. Fink, MC, USN 
Evaluation of Instruction for Hospital 

Corpsmen in Patient Care 26 

LTV.M. Bousquet, NC, USN 



PROFESSIONAL PAPERS (Con.) 

The Endodontic Significance of the Mesiobuccal 

Root of the Maxillary First Molar 29 

LTFJ. Vertucci, DC, USNR 
An Outbreak of Respiratory Disease Misdiagnosed 
as an Adverse Drug Reaction in a Naval 

Recruit Population 32 

CAPT D.F. Hoeffler, MC, USN, 

E.J. Sullivan and 

CAPT C.H. Miller, MC, USN 

NOTES AND ANNOUNCEMENTS 
VADM J.L. Holloway, III 

Nominated for CNO 46 

Norfolk Nav Reg Dental Center Continuing 

Education Programs 47 

New Assignment Policy for HC School 

Graduates 47 

ACDUTRA Opportunities for Naval 

Reservists 47 

Billets Available for Second-Tour Flight 

Surgeons 49 

Call for Papers: Joint Committee on 

Aviation Pathology 51 

Professional Education Available Through 

Navy-Sponsored Programs 51 

Flight Surgeon Curriculum for Family Practice 

Residency AMA-Approved 53 

Former Oceanographer Now MD at 

NAVREGMEDCEN San Diego 55 

Dr. Eilers Addresses NMTI Graduates 55 

In Memoriam 56 



Credits: All pictures are Official U.S. Navy Photographs unless otherwise indicated. 

Honoring the sixty-sixth anniversary of the establishment of the Navy Nurse Corps on 
13 May 1974, U.S. NAVY MEDICINE salutes the valued officers of the Navy Nurse 
Corps. Our front cover displays typical scenes well photographed in 1972 at the 
Naval Hospital, Camp Lejeurte, N.C.: LTJG Yvonne M. Bradshaw comforts a respon- 
sive pediatric patient (left); LTJG Mary A. Valentine makes an intravenous flow ad- 
justment in the coronary care unit (upper right), and; ENS Kandace D. Adams works 
the night shift as a ward charge nurse (lower right). 

The photo on page 2, taken in Sep 1973 during the Surgeon General's visit to the 
Family Practice Clinic at Nav Hosp Pensacola, Fla., shows VADM D.L. Custis, MC, 
USN (left) commiserating with Christopher Martino (right) over black eyes in general, 
and Christopher's in particular. Christopher and the clinic were both one year old 
at the time. First, second, and third-year Family-Practice residents are involved at 
the clinic where well over 1100 Navy families enjoy consulting their own family 
physician.— PAO, Nav Aerosp & Reg Med Cen Pensacola, Fla. 



U.S. Navy Medicine Volume 63, May 1974 




Last March, I spoke of our need for being cost effective. While this emphasis is assuming a 
more important and dominant role in our programs, I want to reemphasize that cost effectiveness 
cannot, and must not usurp the quality of care we extend to our patients. There are those who 
are now saying we place too much emphasis on quality, and that in order to bring costs down, 
"adequate is good enough." Webster defines adequate as "barely satisfactory — acceptable but not 
remarkable." As far as Navy Medicine is concerned, adequate is not and never will be acceptable! 
Our patients are to continue to receive the best care that the state of the art permits today. This 
is the Medical Department's position, cost effectiveness notwithstanding. 

It should not be inferred that we are not fully aware of, and do not appreciate the hard impli- 
cations of this position. Quite the contrary. It will not be an easy task to maintain quality health 
care while experiencing reduced levels of resources, and reaching for cost effectiveness to boot. It 
may even appear to some to be a near impossible goal to achieve, but achieve it we must. There 
is no acceptable alternative. Our patients have a right to quality care, our professional conscience 
demands it, our traditions ensure it, and our survival as a viable system depends on it. 

How do we achieve this near impossible task? During the next several years we will search for, 
evaluate, and adopt new systems and methods of not only health-care delivery, but effective man- 
agement processes as well. In the meantime, we must use every means available today to provide 
quality health care; I will address two that readily come to mind. 

First, the most productive, readily available means to achieve this goal can be found in the 
thousands of professional, highly skilled, trained and dedicated people (military and civilian) who 
constitute the Navy Medical Department. Few health-care systems are as fortunate as ours (and 
our sister Services), to have such a cogent means for accomplishing "impossible goals." However, 
as the thrust and force of every successful organization stems from dedicated and concerned 
people, so the negative forces which mitigate against progress and achievement do stem from the 
few who are unconcerned and uncommitted. In my travels during my first year in office, I have 
noticed that we may have a sufficient number of the latter to perhaps slow down, if not impede 
the achievement of continued quality care in an austere environment. I do not intend to let these 
few people make this happen. Everything possible will be done at the Bureau level to encourage 
such people to rededicate themselves, so that they can make meaningful contributions to the 



U.S. Navy Medicine 



attainment of our goal of quality care. I ask each officer, enlisted, military and civilian member 
in each command, in a supervisory or other position of responsibility, likewise, to exert every 
positive leadership principle and technique, to ensure that every member of our Medical Depart- 
ment is giving his or her full measure of effort; we can tolerate no less if we are to realize 
our goal of quality care in an austere environment. 

Secondly, the other means for achieving this, and other goals can be categorized as "change." 
You know as well as I, that health-care systems cannot survive in a static environment. We 
must change — our Navy is changing, our Nation is changing, and our health-care world is 
changing. For instance, nearly two dozen bills concerning National health insurance are pending 
before both Houses in Congress. The proposed legislation reflects a variety of concepts, sup- 
ported by a number of groups with a stake in the $95 billion health-care industry. A few 
short years ago, one would be hard put to find even the phrase, "National Health Insurance" 
in the Congressional Record. Whether we believe it or not, this shift of emphasis is impacting 
directly and indirectly on our health-care-delivery system. Since we are not an island unto 
ourselves, we too must change, and particularly if we are to maintain quality care in an austere 
environment. For instance, regionalizing the Navy Health-Care-Delivery System was an event 
whose time had come. That change, If effectively supported by all hands, is designed to main- 
tain quality health care. Relieving physicians and dentists of administrative duties is putting 
scarce professionals back in patient care, a change brought on by the shifting emphasis of Na- 
tional health policies. However, there are a few who cannot accept these and other changes, and 
thus do not give them full support. If we are going to provide quality health care while meeting 
the challenges facing Navy Medicine in the next several years, we need not necessarily welcome 
change, but we all must support change and do everything possible to make it work in the best 
interest of our patients. 

In all of our choices in the next several years, we will be involved in the management of 
change. In this regard, every member of the Navy Medical Department in a leadership role will 
have three fundamentally different objectives, two of which may seem contradictory: the preser- 
vation and perpetuation of our system; organizational control; and the generation of desirable, 
orderly change. This conflict is best expressed by Lyndall F. Urwick in his book. Leadership in 
the Twentieth Century: 

"Because foresight is required, the leader always has to be doing two 
apparently incompatible things. He has to encourage his supervisors 
to promote order, to maintain established routines; at the same time, 
he has to protect from their wrath the originals, the innovators, the 
crazy people, to whom order and routine present a challenge to change. 
It is from this, often regarded (as the) lunatic fringe, that the organi- 
zation is most likely to derive something original, 

"This conflict is one of the great paradoxes. The organization that 
cannot resolve it will either go bankrupt tomorrow because it is too 
disorganized to get the job done, or it will go bankrupt in five years 
or less because it is still trying to use the same old methods and sell 
the same old goods or services." 



********* fi(\gr Ei ********* 




Volume 63, May 1974 




DEPARTMENT OF THE NAVY 

AU OF MEDICINE AND 5UR 
WASHINGTON, D.C. 20372 



ANNIVERSARY GREETINGS FROM DIRECTOR, NAVY NURSE CORPS 



It is with genuine pleasure that I extend my 
warmest personal greetings and best wishes 
as we approach the sixty-sixth anniversary 
of the Navy Nurse Corps. 

We reflect with pride on the milestones in 
our history, on the leadership ability, per- 
sonal contributions and laudable achieve- 
ments of our members . Throughout the years , 
our talented, versatile, dedicated and hard- 
working members have been our greatest and 
most indispensable asset. Individuals working 
independently or as members of a team have 
forged the Navy Nurse Corps into a strong, 
efficient organization and a vital part of 
the Navy's health care delivery system, V7e 
are proud to be active participants with the 
members of the Medical Corps, Dental Corps, 
Hospital Corps, and Medical Service Corps, in 
their concerted efforts to fulfill the mission 
of the Navy Medical Department. 

I am confident that through our constant and 
deliberate efforts we will continue to meet 
our obligations and achieve our continuing 
goal of providing optimum patient care to our 
Navy and Marine Corps personnel and their 
families. 

My sincere good wishes to each of you for a 
happy and progressive year ahead. 



Cmi^^A^ 



du: 



ALENE B. DUERK 

Rear Admiral, NC, USN 



U.S. Navy Medicine 



If They Could See Us Now— 

Navy Nurse Corps 

1908-1974 



Individually, men and women still claim the right to 
fudge just a little about their age, but collectively the 
Navy Nurse Corps is proud to admit to 66 years. 

It was 13 May 1908 when Congress first approved 
the organization of a group of 20 women (The Sacred 
Twenty) to aid the Navy's sick and wounded. At that 
time the women were neither commissioned nor uni- 
formed, but specifications for a uniformity of dress 
were issued from time to time by the Navy Surgeon 
General, Not until 1941 did a prescribed uniform for 
members of the Navy Nurse Corps appear in the Navy 
Uniform Regulations. In the pictorial review which 
follows, the evolution of the modern uniform unfolds. 

But what of the persons inside these trappings? By 
their own unselfish, dedicated, and entirely voluntary 
service. Navy nurses have strengthened and bolstered 
the Medical Departmeht in times of war, transition, 
turmoil and peace. Ever responsive to the changing 
needs and persuasions of Navy Medicine, Nurse Corps 
officers have earned respect and recognition by their 
competent performance, indomitable spirit and resolu- 
tion. As a Corps, their impact and advancement stem 
not from a prolonged clamor for equal rights, but 
rather from an endless succession of professional feats 
and enduring commitments. 

Reflecting upon her notable predecessors, our Nurse 
Corps Editor once remarked, "If they could see us 
now!" .... We think they can, and always did. In 
you they are right proud. 




YEARS AGO.— Mrs. Lenah H. Sutcliffe Higbee was the 
second Superintendent of the Navy Nurse Corps, serving in 
that capacity from 1911 to 1922. Here she wears the outdoor 
uniform with standing collar. The Corps device is worn on 
both sides of the collar. A stiff felt hat tops off the ensemble. 
(Some women with flair would opt for the hat today — Ed.) 



Volume 63, May 1974 







gvr&gC 



*■*/?: 



NURSE CORPS LINE-UP.— Navy nurses wore this long white indoor duty uniform in 1914. 




ALL CLOAKED UP.— The long blue cloak, once a symbol 
of the nursing profession, was the Navy's answer to the energy 
crisis of the early 1900s. Miss Josephine Beatrice Bowman 
(left) became the third Superintendent of the Navy Nurse 
Corps in 1922. 



THE MAX I LOOK.— On board the USS George Washington 
in 1918, two Navy nurses wore the coat-cape uniform with 
gold foul anchor device on both sides of the collar. 



U.S. Navy Medicine 




SEEING DOUBLE.— Miss Betty Mayer, assistant superinten- 
dent of nurses from 1923 to 1930, models the white indoor 
duty uniform (left) and cap with cape (right). This uniform 
was adopted 22 Jan 1923. With slight variation in collar and 
material, and great variation in skirt length, it is still the autho- 
rized uniform for female Nurse Corp officers today. 



u. • *■. 



DRESS UNIFORM.— This blue outdoor dress uniform was 
worn by Navy nurses from 1923 to 1942. 




NOSTALGIA NAVY-STYLE.— The war years brought new uniforms with shorter skirts. In 1944, Navy Nurse Corps indoc- 
trinees lined up at Nav Hosp Portsmouth, Va., to model the variations in uniform worn by Navy nurses during the 1940s. 



Volume 63, May 1.974 



FLIGHT NURSE.-ln 1944, Navy flight nurses wore this 
practical slack suit of finely woven, heavy gray cotton broad- 
cloth. Ranks and Corps insignia were worn on the right and 
left sides of the collar, respectively, and the coveted wings 
were worn over the left breast. A jockey type cap with visor 
was also worn. Low-heeled, black Oxford-type shoes were the 
prescribed footwear. 








THE FIFTIES.— The 1950s saw the birth of the "bucket" hat. Flight nurses wore a forest-green uniform. The 
gray-and-white seersucker dress could be worn as an indoor working uniform or, with a change of hats and the ad- 
dition of a tie, for street wear. (Chicago Tribune photo.) 



US. Navy Medicine 





I* 




V 1 


1 B 





THE SIXTIES.— A light blue dacron uniform was intro- 
duced in the 1960s. It was the beginning of the end for the 
traditional blue cape. 




THE "NEW" LOOK.— There was a new look in Navy nurses 
when men joined the Nurse Corps in the mid 1960s. Male 
nurses wear the uniform authorized for all male Naval officers. 
This tropical white uniform converts to the indoor working 
uniform for male nurses, by removing the shoulder boards and 
adding collar devices. 




THE SEVENTIES.— In the 1970s, 
Navy female nurses moved into short 
skirts and pantsuits. Here RADM 
Robert Williams, Jr., MC, USN (left), 
CO, NNMC, introduces comedian Bob 
Hope to Navy staff nurses (CDR H.I. 
Furmanchik, left; ENS L. Sinowski, 
right), at the National Naval Medical 
Center, Bethesda, Md.S? 



Volume 63, May 1974 




ALL PRESENT AND ACCOUNTED FOR.— The ambulatory-care nurse practitioner's 
continuing education program includes three hours of seminars and conferences each week. 
Each nurse is responsible for conducting a seminar. 



Ambulatory-Care 



Nurse Practitioner Program 



By CDR Angeline G. Liakos, NC, USN, 

Director, Ambulatory Care Nurse Practitioner Program, 
Naval Regional Medical Center, San Diego, Calif. 92134. 



The changing economic base for health services (as 
exemplified by medicare, health maintenance organiza- 
tions, and other prepaid health insurance plans) has 
made health care financially feasible for more people 
than ever before. Comprehensive health insurance 
plans, however, do not assure the availability of suffi- 
cient numbers of professionals for the delivery of health 
care services. 

Medical and nursing leaders are confronted with the 
problem of bringing better health care to a continually 
increasing number of patients. One highly promising 
solution to this problem is for nurses to function at 



The opinions and assertions contained in the above article 
are those of the author and do not necessarily represent official 
views of the Navy Department, or the naval service at large. 



maximum capability as partners in the health team 
responsible for delivering comprehensive care. 

In 1970 a committee of thirteen doctors, thirteen 
nurses and two hospital administrators was appointed 
by the Secretary of the Department of Health, Educa- 
tion and Welfare (HEW) to study possible extended 
roles of nurses. The committee's report In 1971 stated: 
"One of the most important opportunities for change in 
the current system of health care involves altering the 
practice of nurses and physicians so that nurses assume 
considerably greater responsibility for delivering primary 
health care services." The committee used the term 
"primary care" to describe a patient's initial contact 
with a health-care system; in this initial contact a plan 
of treatment would be determined, and responsibility 



10 



US. Mavy Medicine 



assigned for the continuum of patient care, including 
maintenance of health, evaluation and management of 
symptoms, and appropriate referrals. 

Navy nurses are responding to the challenge of as- 
suming greater responsibility with enthusiasm and imagi- 
nation. One manifestation of the creative change now 
taking place in Navy nursing is the Ambulatory-Care 
Nurse Practitioner Program instituted last year at Naval 



Regional Medical Center (NAVREGMEDCEN), San 
Diego, Calif. Development of this new program was 
prompted by growing recognition of the importance of 
nurse-physician collaboration in extending increased 
health-care services to ambulatory patients. Given 
proper training and supervised experience, and working 
interdependently with physicians. Navy nurses are dem- 
onstrating their ability to assist such patients. 




PRIMARY SCREENING.— LCDR Claire Cronin, NC, USN 
(left), a nurse practitioner, helps expedite patient care by as- 
sisting with the primary screening of a patient. 




X-RAY STUDIES.— LT David L. Vandenberg, MC, USN 
helps LCDR Betty Thomas, NC, USN to identify radiological 
features of a pyelogram study performed on one of her patients. 




CHECK OUT.— Under the supervision of LCDR Ronald P. DiGiacomo, MC, USN (right), 
LTJG Wendy Bregar, NC, USNR (left) checks the status of a cardiac patient. (Photo by 
Joanne Kane.) 



Volume 63, May 1974 



11 




SPECIALTY CLINICS.— Hematoiogist LCDR Robert F. 
Granatir, MC, USN (left) teaches LTJG Marilyn Stryker, NC, 
USNR (right) the proper technique of palpating the abdomen. 
Assignment to such specialty clinics provides the nurse practi- 
tioner with a variety of learning opportunities. (Photo by 
Joanne Kane.) 




CLINICAL CLUES.-LTJG Marilyn Stryker, NC, USNR ex- 
amines smear specimen taken from an inpatient. Nurse practi- 
tioner students rotate through the dermatology, urology, neu- 
rology, and surgery clinics. 




JUST TESTING.— LT Dianne Sentinella, NC, USN {second 
from left) elicits a neurologic response from her patient for 
LCDR Roger E. Fitzpatrick, MC, USN (far left), and LCDR 
Claire Cronin, NC, USN (right). After two years of clinical 
experience, the nurse practitioner will be eligible to apply for 
national certification by the American Nurses' Association. 



The Ambulatory-Care Nurse Practitioner Program is 
designed to offer the education and experience required 
by a nurse to deliver primary health care, as defined 
by the HEW committee. During the six-month pro- 
gram of formal classes and supervised clinical experi- 
ence, the training includes: assessment of the health 
status of individuals; response to illness; compliance 
with, and response to prescribed treatment; screening 
of patients to gather data which will be evaluated to- 
gether with the physician; ordering selected diagnostic 
procedures; and managing selected patients in associa- 
tion with, and under the supervision of a medical offi- 
cer (entailing physical examination, determination of 
clinical diagnosis, prescription of medication, and re- 
ferral when indicated). 

During the first two months of the initial program, 
27 physicians gave medical lectures and demonstrations. 
CDR Martin Passaglia, MSC, USN and LT Douglas 
Call, MSC, USN, physiologists from NAS Miramar, 
Calif., helped teach 22 hours of anatomy and physi- 
ology. LT Darrell Snook, MSC, USN taught applied 
pharmacology. Under the very capable leadership of 
Shirley Kashoff, Ph.D., ambulatory-care nurse practi- 
tioner students considered ways of identifying and 
coping with inherent stresses in their new extended 
role. Other topics discussed included microbiology, 
problem-oriented medical records, and interviewing 
techniques. 

With guidance and support from the medical staff, 
the nurse practitioners received additional experience 



12 



US. Navy Medicine 




PROGRAM PROTEGES.— Under the guidance of Medical 
Corps officers like LCDR Roger E. Fitzpatrick, MC, USN (cen- 
ter), nurse practitioners LT Lita Fillmore, NC, USN (left! and 
LCDR S. Knouse, NC, USN (right) gain experience in the effec- 
tive use of problem-oriented records. 



in taking histories and conducting physical examina- 
tions of inpatients and outpatients. A four-month 
clinical rotation was implemented to provide experi- 
ence in: otolaryngology, gynecology, internal medicine, 
adolescent medicine, ambulatory care, and the emer- 
gency room. Students could also elect to rotate to the 
dermatology, urology, neurology, and surgery clinics. 
Personnel from other services such as pharmacy, labora- 
tory, and radiology also supported the program. 

The first nurses to emerge graduated from the pro- 
gram in formal ceremonies conducted on 1 1 Jan 1974. 
The new ambulatory-care nurse practitioners are now 
assigned to the Ambulatory Care Service of NAVREG- 
MEDCEN San Diego, and to three of the annex dispen- 
saries within the regional command. 

The nurses' educational continuum will include three 
hours of seminars and conferences to be conducted 
each week. Further expansion of nurses' duties, to in- 
clude the role of the family-care nurse practitioner, is 
envisioned. After the successful completion of two 
years of clinical experience, the nurse practitioners will 
be eligible to apply for national certification by the 
American Nurses' Association. 

The Ambulatory-Care Nurse Practitioner Program at 
San Diego is under the direction of CDR Angeline G. 
Liakos, NC, USN. CAPT John Schanberger, MC, USN 
is medical adviser. The program has been enthusias- 
tically supported by the medical and nursing staff of 
NAVREGMEDCEN San Diego, and has won patient 
acceptance at the Medical Center. 




PROGRAMED PRACTITIONERS.-CDR Angeline G. 
Liakos, NC, USN (center), director of the Ambulatory-Care 
Nurse Practitioner Program, reviews the programed instruction 
on otitis media with LT Deborah Sherman, NC, USN (left} and 
LT Lila Fillmore, NC, USN (right). (Photo by Joanne Kane.) 




PRIMARY HEALTH CARE.— Licensed vocational nurse 
(LVN) Mrs. O. Myers (right) will prepare patient for examina- 
tion by LTJG Margaret Willey, NC, USNR (center). The ob- 
jective of the Ambulatory-Care Nurse Practitioner Program is 
to provide the nurse with the education and experience she 
needs to deliver primary health care. (Photo by Joanne Kane.lflf 



Volume 63, May 1974 



13 



PEDIATRIC WEIGHT CONTROL: 
Fun and Games 



By LCDR Phyllis Barkus, NC, USN,* 

Mrs. Cynthia Brach, MA, Registered Dietitian,** and 
LT Betty Starr, MSC, USNR.t 



INTRODUCTION 

The incidence of obesity in children has been in- 
creasing steadily since 1950. The data suggest that 
obese children may not outgrow their fatness, but 
rather that the problem may become worse with age.^ 
In fact, severe obesity among adults has generally been 
found to have had its onset in childhood. 

Nutrition educators feel that the problem of obesity 
may be partly attributed to nutrition misinformation. 
One source of such misinformation is television adver- 
tisement that attempts to stimulate a child's appetite 
for "goodies," such as the commercial which asserts 
that a candy bar is equal in nutritional value to a glass 
of milk. Other obstacles to good nutrition are the 
many self-appointed food experts who lecture on health 
foods, own or operate health-food stores, or write best- 
seller books on pseudonutrition. Most reputable 
nutritionists agree that effective nutrition education is 



Materials used in the Weight-Control Program herein de- 
scribed (lesson plans, advertising poster, anthropometric chart, 
"Slender" card, and classroom skit) are available upon request 
from: Food Management Services, Naval Regional Medical 
Center, Long Beach, Calif. 90801. 

*LCDR Barkus is currently doing Navy-sponsored graduate 
work in pediatric nursing at the University of Utah, Salt Lake 
City. 

**Mrs. Brach is a staff member at the Naval Regional Med- 
ical Center Long Beach, Calif. 90801. 

+ LT Starr has been released from active duty. 

1. Read MS and Heald FP: Adolescent obesity: a sum- 
mary of a symposium, J Am Diet Assoc 47:411, 1965. 



the best method for counteracting such misinforma- 
tion. 2 

Until April 1973, weight reduction classes at the 
Naval Regional Medical Center, Long Beach, Calif,, 
were designed for the overweight adult, and only 
individual diet instructions were given to overweight 
children. We learned, however, that the majority of 
overweight adults who came for classes had been over- 
weight since childhood. The Food Management Ser- 
vices and the Pediatric Department therefore decided 
to establish an informative, interesting, and entertain- 
ing program for obese children, which would entice 
them to attend each meeting and motivate them to 
lose weight. Two classes a month were scheduled: 
one session for children new to the program, and 
another session to provide continuing education and 
learning experiences for children already enrolled in 
the program. 

CLASS METHODS 

Since most of the children in the program are of 
school age, classes are scheduled from 1600 to 1700 
hours. For the first class, three members of the staff 
who volunteer to be group leaders change from their 
military and work uniforms to Levis, T-shirts, and 



2. Wagner MG: 
57:311, 1970. 



The irony of affluence. J Am Diet Assoc 



14 



US. Navy Medicine 




A-WEIGH WE GO.— Each child's height and weight are 
recorded on an anthropometric chart during the first session 
of the Pediatric Weight Control Program at NAVREGMEDCEN, 
Long Beach, Calif. (Photos by HM2 J.C. Spencer) 



tennis shoes. Leaders, children, and parents all wear 
name tags which identify them by their first name only. 

The class begins with the question, "Do you know 
why you are here and what you all have in common?" 
The answer to this question is, "Yes. We are all too 
fat." Next the group is told that they will learn: (1) 
what calories are; (2) where calories come from; (3) why 
we need calories; (4} the causes of weight gain, and the 
effect of weight gain on the body; (5) the basic four 
food groups and food-exchange lists, and; (6) how to 
plan meals using the food-exchange lists. 

To keep the children's attention, the leaders take 
turns discussing these topics. The children are then 
asked to bring 'in six pictures of food items that they 
clip from newspapers and magazines. The children 
identify the exchange list that each food picture repre- 
sents. Food-exchange lists and meal patterns are distri- 
buted for home use. 

At the conclusion of the first class, each child's 
weight and height are recorded on an anthropometric 
chart, 3 to ascertain the child's degree of obesity and 



approximate ideal weight. The findings are then ex- 
plained to the child and his parents, who are also shown 
how to use the anthropometric chart. 

Children are expected to keep a record of their pro- 
gress. At each return visit, the child is weighed to de- 
termine whether weight loss or gain has occurred. A 
poster representation of a horse race is used to drama- 
tize weight loss; as each child loses weight, his horse is 
moved further along the track. For each one-quarter 
pound of weight loss, the child receives a 25i token. 
But if his weight has increased, a 25(5 token must be 
returned for each one-quarter pound gained, and the 
child's horse is moved in reverse. Every three months 
an auction of toys and other useful items is held. The 
children may use their tokens to bid for whatever they 
want. This auction provides the children with a tangi- 
ble incentive to lose weight, and amass tokens. 

In the second session, we reinforce the use of the 
food-exchange lists by playing a game called, "Slender." 
"Slender" is played like "Bingo," with items of food 
being called instead of numbers. The game continues 
until every child has won a prize. 

The third session is called "Creative Salad Making." 
A variety of raw vegetables is collected, including cab- 
bage, cauliflower, celery, cucumbers, lettuce, mush- 
rooms, bell peppers, radishes, zucchini squash, cherry 
tomatoes, and turnips. Each child washes, cuts, and 
prepares two or three of the vegetables. Prepared and 
homemade diet salad dressings are also available. The 
children and their parents are encouraged to taste all 
the vegetables and dressings. 

The fourth session, "Exercise Your Weigh Down," 
is very popular. The objective is to demonstrate that 




3. Anthropometric Chart. The Children's Medical Center, 
Boston, Mass. 



ON STAGE.— Children enrolled in the Pediatric Weight Con- 
trol Program work with their parents and group leaders on a 
skit which they will present at a Christmas party. The skit 
presents basic principles of nutrition in an interesting and 
amusing way. 



Volume 63, May 1974 



15 




RACE TOWARDS S LIMN ESS.— This horse-race poster helps 
children in the Pediatric Weight Control Program to monitor 
their weight loss. The horses move ahead whenever a child 
loses one-quarter pound of weight. 



exercise can be fun, and that it has an important role 
to play in maintaining good health. Three teen-agers 
help out with this particular program by demonstrating 
a few clever dance steps called the "Monster Mash." 
A volleyball net (which Special Services was kind 
enough to lend) is set up and the children play several 
games; the last game pits the children against the 
parents — and guess who usually wins! 

One of the principles we try to reinforce is that 
water is the best thing to drink after any physical 
activity. But, as a reward, eight flavors of noncaloric 
diet soft drinks are also served. 

In the fifth session, we again play the game of 
"Slender." This game serves a dual purpose: it helps 
us to ascertain how much the children have learned, 
and the prizes give the children positive reinforcement 
of their new knowledge. 

The authors served as leaders of the first group of 
classes, and wrote a short skit which the children en- 
acted before their parents and friends as part of their 



Christmas party last December. The skit is humorous, 
informative, and appeals to students from age 5 to 13 
years. 

RESULTS 

The program has not been in effect long enough to 
determine the long-term results of this effort. By the 
end of the first ten months, three of the 20 participants 
had moved, and one had stopped attending classes. 
But of the 17 remaining children, only two had not 
shown a weight loss. One child had lost 5Va pounds 
and grown two inches. At the end of 1973, the total 
weight loss for the group was 39 pounds. As an addi- 
tional benefit, one mother has lost 17 pounds and one 
father has decided to go on a diet with his daughter. 

All of the sessions have been well received, and the 
parents have been very cooperative in bringing the 
children to class. The program appears to be a success, 
and will be continued as a regular service of the Long 
Beach Naval Regional Medical Center. Any new ideas 
or suggestions that may be useful in planning future 
sessions would be appreciated. 

SUMMARY 

Because of the increasing number of obese children, 
many of whom become obese adults, a long-term group 
program of weight reduction for children was initiated 
in 1973 in the Pediatric Clinic of the Naval Regional 
Medical Center, Long Beach, Calif. This program offers 
continuous nutrition education, along with immediate 
reward for actual weight reduction, Although the 
children are primarily interested in improving their 
personal appearance, the lessons they learn about good 
nutrition will help them to maintain a lifelong program 
of weight control. Hopefully, the children will absorb 
and profit from the information received on the causes 
of weight gain, methods for maintaining ideal body 
weight, and fundamental principles of effective, sensible, 
weight reduction.?? 



ARMED FORCES DAY 



By proclamation of President Nixon, the third Saturday of each May has been designated Armed 
Forces Day, to enhance public understanding and appreciation of the Armed Forces as protectors of 
freedom at home and abroad. 

Secretary of Defense James R. Schlesinger has directed that special tribute be paid, on May 18, 
to the personal sacrifices which men and women in uniform continue to make in the line of 
service.?? 



16 



US. Navy Medicine 



CAREER PLANNING for 

MEDICAL OFFICERS in the NAVAL RESERVE 



By CAPT Khlar E. McDonald, MC, USNR-R 
Training and Support Unit 3-55, 
Naval Reserve Center, Jamestown, New York. 



INTRODUCTION 

The initial step in career planning in the Naval Re- 
serve community is affiliation with an active reserve 
component. Today there is ample opportunity for a 
Reserve medical officer, upon his release from two 
years of active service, to affiliate with an interesting 
program in the Air, Surface, Seabee, Marine Corps, or 
Reserve Medical Company. 

Many rewarding contributions can be made by the 
physician who is enthusiastic, patient, and dedicated to 
the preservation and welfare of our Nation. A deep 
sense of patriotism is essential. 

The United States and Its territories are geographi- 
cally divided into Naval Districts. One of the primary 
tasks of each Naval District is the continued develop- 
ment, maintenance, and support of a responsible Naval 
Reserve Program. The location of the nearest reserve 
facility and the available opportunities in medical as- 
pects of the Naval Reserve Program may easily be 
ascertained by contacting the office of the District 
Medical Officer (DMO) in the District Headquarters. 
Often local reservists can be of some assistance in 
locating the nearest facility. A visit to the area facility 
will usually provide the necessary information, and an 
opportunity to affiliate in an active reserve status. 

At this point the many advantages of being a mem- 
ber of an active reserve component might be considered. 



The opinions and assertions expressed in the above article 
are those of the author and are not to be construed as official, 
or necessarily reflecting the views of the Navy Department or 
the naval service at large. 



The following benefits are readily apparent: 1) educa- 
tion and training in many areas; 2} association with 
leaders of the area, immediately providing both social 
and business contacts; 3) opportunity for further pro- 
motion in the Navy; 4) retirement program; 5) survivor's 
protection while in a duty status; 6) individual medi- 
cal care for illness or injury while in a duty status; 7) in- 
come tax deduction for involved travel and incurred 
expenses; 8) a monthly pay check while in a pay status; 
9) $15,000 life insurance coverage while in a duty 
status, and; 10) pride and satisfaction in the knowledge 
that Naval Reservists are ready, willing, and able to 
assist in the defense of the Nation against all aggres- 
sors. 

Depending upon individual qualifications and inter- 
ests, the types of billets available to the Reserve medical 
officer are varied and often flexible. In the Training 
and Support Units he may function as a support Gen- 
eral Medical Officer (GMO), and in a Staff advisory 
capacity. In the District he may function as the Com- 
mandant's Representative at an adjacent medical school. 
In this capacity his major task is that of informing 
embryo physicians of the opportunities in military 
medicine, and actively recruiting young physicians for 
Navy Medical programs. As an interested medical 
officer he may opt to supervise the training of hospital 
corpsmen in any unit to which a reasonable number 
of corpsmen are attached. Flight Surgeons are con- 
tinuously involved in the Reserve Air Program. Seabee 
and Marine units welcome interested Reserve medical 
officers to assist them. There are 23 organized Reserve 
Medical Companies in existence today, offering oppor- 
tunities in both pay and nonpay status, ranging from 



Volume 63, May 1974 



17 



clinical specialty service in a hospital or dispensary 
environment, to special medical projects including cur- 
rent training in the military aspects of Navy Medicine. 



CAREER PLANNING 

As in any other successful career, a career in the 
Naval Medical Reserve requires careful planning, with 
constant reevaluation. Physicians today have many 
family, social, and professional obligations that compete 
for their time and knowledge. The successful Career 
Reserve Officer must include in his planning these basic, 
minimum requirements: 1) regular participation, 2) ac- 
tive duty for training, 3) continued educational growth 
and development, and 4) leadership development and 
experience. The advantages of such a planned career 
are: the respect of your community and less military- 
minded associates; the gratitude of the United States 
Navy, and; hopefully, regular promotions with a guar- 
anteed retirement benefit. 

Regular Participation. 

The initial step is the association with an active re- 
serve program. Regular attendance at the established 
meetings of the unit which you join is of utmost im- 
portance. This affords the Reserve medical officer both 
the opportunity to perform a regular useful function, 
and to become acquainted with the problems and mis- 
sion of his particular unit. Today the performance of 
medical duties required in the normal administration 
of a given unit is basic, but the interested medical 
officer can and should become involved in the military 
program. The individual expertise which he brings to 
the unit can be valuable in creating an enthusiastic, 
positive attitude that generates success in any viable 
organization. Physicians are noted for their industry; 
this quality will affect your Navy associates if you in- 
fect them with your knowledge and enthusiasm. Posi- 
tive leadership is readily exerted by participation in the 
training programs of the unit wherever possible, and 
by promoting the Navy in your community. Military 
bearing, and conformity to the uniform and other basic 
regulations are, of course required. The grass-roots 
public still respect and favor the smartly dressed Naval 
officer. 

Active Duty for Training. 

Active duty for training (ACDUTRA) is essential for 
a successful naval career. This provides an opportunity 
for the reservist to remain current on what is happen- 
ing in the Naval establishment. It also provides the 
chance to serve, and to make a meaningful contribution 



to the Navy Medical Corps. If the junior officer is not 
familiar with ships and the medical problems of the 
fighting Navy, a period of active duty for training spent 
on a ship at sea will readily broaden his Navy experi- 
ence. Duty at naval hospitals, and participation in the 
many special projects and schools provided for Naval 
Reserve medical officers are also extremely rewarding; 
such practical experiences extend the qualifications of 
the medical officer. Serious consideration should be 
given to this 14-day period of active duty. Early in his 
career, the Reserve medical officer should develop a 
long-range plan for ACDUTRA, so that his overall 
experience will include sea duty, naval hospital and 
dispensary service, exposure to the administrative as- 
pects of military medicine, duty with the Marines and 
Seabees, exposure to aviation and space medicine, and 
Staff or War College duty. 

Continued Education. 

Today postgraduate education is just as important 
for the military career as it is for civilian practice. Up- 
on his release from active duty the young medical of- 
ficer should seriously consider graduate training in his 
particular area of interest, whether it be family medi- 
cine, general medicine or its subspecialties, general sur- 
gery or its subspecialties, anesthesiology, obstetrics and 
gynecology, etc. Board certification in the chosen area 
of interest will be important in acquiring and maintain- 
ing the desired privileges which a young physician seeks 
in both civilian and military environments. Many state 
and national organizations now require continued par- 
ticipation in graduate medical educational programs. 
With peer and hospital-utilization reviews eminent, 
only medical practice of measurable-standard quality 
will be found acceptable to society. In time of great 
need, the Reserve medical officers must be willing and 
capable of filling that need. 

Leadership Development. 

Leadership capabilities are acquired, not innate. 
There are abundant opportunities in the civilian medi- 
cal community for the physician to nurture, test, and 
perfect his ability as a leader of men, in addition to his 
responsibility as a chief member of a medical-care team. 
The physician should readily accept responsibility as a 
member of the hospital staff and indigenous medical 
societies, in order to assimilate experience at the various 
levels of accountability in these organizations. Partici- 
pation in selected community activities and organiza- 
tions will provide experience beyond the medical field, 
and will prove both rewarding and challenging. The 
research and acquisition of knowledge of the elements 
basic to good leadership, and their judicious application, 



18 



US, Navy Medicine 



cannot be overlooked. Knowledge and experience, 
coupled with hard work, inevitably generate success. 
There will always be an unsatiated requirement for out- 
standing leadership. 

CONCLUSION 

A medical career in the Naval Reserve should be ini- 
tiated by a love of the Navy, and a desire to serve in 



it. This career development must be based on a long- 
range viable plan that provides growth and progression, 
in both the military and professional aspects of the 
Medical Corps. Continued medical education, and the 
willingness to develop leadership responsibility will 
round out the career pattern. The usual reward for 
such effort and commitment, having availed oneself 
of the opportunity to serve, is that of profound satis- 
faction.^? 




ARMED FORCES DAY, MAY 18 



Volume 63, May 1974 



19 



Pediatric Hospitalization and 
Integrity of the Family Unit 



By LT Richard E. Peterson, NC, USIMR, 
Instructor, Hospital Corps School, San Diego, Calif. 



Parents who bring their child to a hospital because 
of failure to thrive, are advised by a nurse that their 
child "is finally in good hands." .... The charge 
nurse of a pediatric unit instructs the staff that "chil- 
dren should only be hit on the behind, never on the 
face." .... Parents who are not allowed to visit their 
child in his hospital room, are obliged to wave and 
gesture through a window .... Having witnessed these 
disturbing events at a public hospital, my interest in 
the family as a unit was aroused; I was determined to 
explore the effects of illness on children and their 
parents, to determine the extent of proper nursing in- 
tervention in patient care. 

The family is a basic integral unit of society, and 
serves as the child's primary group. The varied func- 
tions of the family afford love and affection for the 
child, and affect the development of the child's per- 
sonality and values. 

Today there are many events and people, external 
to the home and family, that strongly influence child 
development. School, church, clubs, and friends make 
substantial contributions to the maturation of a child. 
However, the provision of love and affection largely 
remains in the domain of the family; it is difficult for 
an agency to assume the latter function in a compa- 
rable manner. 

The significance of the family unit is readily demon- 
strated when one member is endangered through illness; 



At the time when this article was prepared, LT Peterson 
was charge nurse of the Pediatric Ward at IMav Hosp Great 
Lakes, III. 

The opinions and assertions contained herein are those of 
the author and are not to be construed as official, or reflect- 
ing the views of the Navy Department or the naval service at 
large. 



the remaining family members will unite to maintain 
integrity. Nurses, doctors, and ancillary personnel who 
provide medical services for children may do well to 
consider family unit integrity — its value and preserva- 
tion. 

Children have distinctive anatomic and physiologic 
features which are unlike those of adults; children are 
not, in fact, "compact adults." Equally important are 
the psychologic aspects of illness for the child, who 
fails to comprehend the magnitude of illness and can- 
not understand the need for hospitalization. 

Frequently parents themselves are uninformed, find- 
ing it difficult to appreciate the medical status of their 
child and the reason for hospitalization. Flowing from 
this lack of realistic perception, mixed emotions erupt; 
these must be understood and accepted by the nursing 




BABE IN ARMS.— Secure in her refuge, the 6-month-old 
daughter of Mrs. Gabriela Sunga happily accepts examination 
of her chest by CDR Charles Reed, MC, USN in the Pediatric 
Clinic of Nav Hosp Great Lakes, III. Assisting the group is 
LTJG Peggy Marine, NC, USNR. 



20 



U.S. Navy Medicine 




I'D RATHER SLEEP.— Helping a young patient feel com- 
fortable in the hospital is an important part of the nurse's job. 
Here ENS Judith Johnson, NC, USNR comforts a weary pa- 
tient on the Pediatric Ward of Nav Hosp Great Lakes, 111. 



staff if good care is to be provided. In addition, 
nursing personnel must understand their own feelings 
about families. Nurses must accept the fact that the 
guise of parental substitute no longer constitutes a 
nursing role. Rather, nurses should serve as a tempo- 
rary assistant to the family in returning the child to 
norma! activity. Hopefully, nurses can persuade pa- 
tients that hospitalization is necessary to allow special- 
ized therapy not available in the home. 

Children often react to illness with anger, fear, guilt, 
or disappointment. The course of events leading up 
to hospitalization often determines, or colors the feel- 
ings which they harbor or express. Consider the fol- 
lowing example: While crossing a street he had been 
forbidden to cross, a child is struck by a car and sus- 
tains a fractured femur. The child may feel guilt; fear 
of the parent (because he violated a rule); anger at the 
driver of the car, and; bitter disappointment at finding 
himself in a strange environment, immobilized and in 
traction. Parental sentiments might also include anger, 
fear, guilt, or disappointment. Parents may feel anger 
toward the automobile operator, or toward the child 
who disobeyed; fear for the child's medical plight; guilt 
over breakdown in supervision of the child, and; 



disappointment that the child had disregarded parental 
direction. Nurses must consider the needs and emotions 
of the entire family, in securing coordinated effort to 
provide optimal patient care in the hospital and at 
home. 

Honesty is required in a parent-child relationship, to 
maintain the child's trust. Children should also be en- 
titled to trust nursing personnel. Such faith is some- 
times undermined by parents who threaten the child 
with such statements as: "I'll have the nurse give you 
a shot if you don't do what I say," or, 'The shot won't 
hurt at all." It may be difficult to achieve honest inter- 
action while maintaining respect for the parent-child 
relationship, but it is possible and highly desirable. 

At Nav Hosp Great Lakes, III., several innovations 
have been implemented to accommodate the family- 
unit concept. The Pediatric Clinic is open until 2200 
hours, thereby permitting many children who might 
otherwise have been admitted through the emergency 
service during the evening, to be returned home after 
consulting a pediatrician in the clinic. The physician 
who conducts the evening pediatric clinic routinely 
visits the ward after clinic hours, checking further on 
any problems. 

When children are admitted to the hospital, the 
family is also "admitted," and made comfortable on 
the ward. A short interview is conducted to determine 
specific factors in the individual care of the child, and 
the "Pediatric History" standard form is completed. 
The physician generally completes the admission phys- 
ical examination at this time, and interviews the parents 
in greater detail. 




CHECKING IN.— At Nav Hosp Great Lakes, 111., ENS 
Bonnie Banker, NC, USNR reviews Michele White's medical 
history before the child is seen by a pediatrician. Michele was 
brought to the Pediatric Clinic by her parents, PN1 and Mrs. 
Howard White. 



Volume 63, May 1974 



21 




BEDSIDE VISIT.— Hospitals aren't too frightening when 
someone takes the time to explain things. Here LT Richard E. 
Peterson, NC, USNR, charge nurse ort the Pediatric Ward at 
Nav Hosp Great Lakes, III., shows David Free the special kind 
of bandage used to protect his head. 



Visiting hours have been altered to satisfy the needs 
of families. Pre- and postoperative visits are planned. 
Scheduled visiting times are 1500-1900 hours on week- 
days, and 1200-1900 on weekends; families may there- 
fore be together at mealtimes. Changes in these hours 
are made when necessary to accommodate family visits. 
During visiting hours, nurses may observe family inter- 
actions and gain valuable insight into the reactions of 
children and parents to hospitalization. 

Parents whose children are entrusted to surgical 
specialty services may visit at breakfast time, when the 



doctors make rounds before departing to the operating 
rooms, and reports of children's medical progress can 
be obtained during these visits. Parents whose children 
are hospitalized on the medical service may generally 
converse with the ward medical officer in the afternoon. 

A written pediatric information sheet is given to each 
family. The sheet provides telephone numbers for the 
ward, so that parents may call at any time to receive 
a progress report. Hopefully, this policy reassures the 
parents that their child's condition is readily ascertained. 
Nurses also work with parents to educate families in 
providing health care at home. Keeping parents in- 
formed and involved in the child's health-care plan helps 
to maintain the family unit. 

Classes are held for ward personnel who explore their 
own attitudes, as well as the attitudes of the child and 
his parents. Details of patient care, growth and devel- 
opment, and use of patient-care plans are also regularly 
discussed. 

In summary, the pediatric staff seeks to maintain 
family integrity. This is accomplished by observing 
and understanding the family's feelings, keeping the 
family informed of the patient's progress, and teaching 
the family to care for the patient in the hospital and 
at home. The nurse in a starched uniform, who once 
whisked a child away from his parents' arms, has now 
been replaced by the enlightened professional who 
strives to unify families through empathy and care. 

SELECTED BIBLIOGRAPHY 

1. Blake FG, Wright FH and Waechter EH: Nursing Care 
of Children. 8th ed, Philadelphia, JB Lippincott Co, 1970. 

2. Marlow DR: Textbook of Pediatric Nursing, 2nd ed, 
Philadelphia, WB Saunders Co, 1965. 

3. Petrilo M and Sanger S: Emotional Care of Hospital- 
ized Children. Philadelphia, JB Lippincott Co, 1972. 

4. Winch RF: The Modern Family, New York; Holt, 
Rinehart & Winston Inc. 1966.W 



THREE NEWPORT COMMANDS CONSOLIDATED 

A special consolidation ceremony marked the launching of the new Naval Education and Training 
Center (NETC) recently in Newport, R.I. 

During the program, three commands were formally disestablished and consolidated into the new 
command. They were the Naval Base, Naval Station and Naval Officer Training Center. 

The March 29th ceremonies marked the principal action involving Newport shore commands un- 
der the Naval Shore Establishment Realignment (SER) plan announced 17 Apr 1973. 

Two other Newport commands, the Navy Public Works Center and Naval Supply Center, Norfolk, 
Newport Annex, will be absorbed by NETC on July 1st. — NAVNEWS, No. 0104, 19 Apr 1974.?? 



22 



US. Navy Medicine 



The Craniotomy Check Sheet: 

A Graph-Form Index of Clinical Evolution 



By LCDR Lawrence H. Fink, MC, USN, 
Assistant Chief of Neurosurgery, 
National Naval Medical Center, Bethesda, Md. 20014. 



INTRODUCTION 

It is essential to the management of any patient fol- 
lowing cerebral insult of whatever etiology (injury, 
hemorrhage, craniotomy), that the patient's neurologic 
status be periodically evaluated and recorded, and a de- 
termination made regarding the evolution of the clinical 
situation. In simple terms, it is necessary to know at 
any given moment, "How is the patient," and, more 
importantly "How is he as compared to a few hours 
ago"? 

To this end, most, if not all neurosurgical services 
prescribe a standardized set of repeated clinical evalua- 
tions, the analysis of which provides an indication of 
the evolving clinical condition of any given patient. 
These examinations may be as cursory as checking pu- 
pillary size, Babinski's signs, and responsiveness. More 



The opinions and assertions contained in the above article 
are those of the author, and are not to be construed as official 
or reflecting the views of the Navy Department, or the naval 
service at large. 



effective is the routinized evaluation of several neuro- 
logic parameters (craniotomy checks), which are listed 
on a printed form with space provided for recording 
results or symbolic notations. The so-called "Craniot- 
omy Check Sheet" serves the purpose. 

Unfortunately, the mere listing of various critical 
parameters to be evaluated, and checking them off, may 
not always provide useful information. Even more un- 
fortunate is the possibility that nursing-service person- 
nel (nurses, corpsmen) who are charged with the care 
of such patients, may continue recording isolated ob- 
servations, blissfully unaware that the combination of 
signs being recorded indicates a seriously deteriorating 
clinical situation. The responsible physician may never 
learn of the apparent clinical deterioration until it is, 
perhaps too late to reverse the downward trend. 

THE CHECK SHEET 

To prevent this situation, we have developed a new, 
standardized Craniotomy Check Sheet (NDW-NNMC- 



Volume 63, May 1974 



23 



MDW-NNMC-6460/5 (R.v. «-73) 



CRANIOTOMY CHECK SHEET 



ORIENTAT . N APPROPRIATL 
CONFUSED 






FLEXOR 



5 EXTENSOR 



NONE 



STRENGTH f 0-4) 



PURPOSEFUL 



FLEXOR 



EXTENSOR 



NONE 



STRENGTH (0-4) 



SIZE firm.) 



^ LLM REACTION f+ o r -) 



TIME - (00 HOURS) 




if 



SIZE (mm.) 



RIGHT ^^ ^-J 

REACTION (+ or -) 



* $ 



+■ + 



5 S 



+ -h 





PURPOSEFUL 




















FLEXOR 

n r 
































= EXTENSOR 


































NONE 
















































STRENGTH (0-4) 


Z 


Z 
















Z 


3 














* 
















PURPOSEFUL 






































z 


. FLEXOR 






























o 

1— t 


^ EXTENSOR 
































d 


NONE 










































^ 


STRENGTH (0-4) 


3 


3 










3 
















V 












PURPOSEFUL 

















































ADDRESSOGRAPH 



INSTRUCTIONS: Blacken entire box, unless a 
number is required (See over) 
Chart pupil size in comparison to circles printed below. 
Chart reaction as + (reacts) or - (does not react) 
PUPIL SIZE (mm.) 



•"-: 



f f 



Figure 1.— The Craniotomy Check Sheet.— Several boxes are blackened in order to illustrate a hypothetical trend 
in a case of resolving right hemiparesis. Note instructions given in lower right corner of the chart. 



24 



U.S. Navy Medicine 



6460/5 [Rev. 6-73]), which has been utilized satisfac- 
torily at the National Naval Medical Center, Bethesda, 
Md., for the past six months. This check sheet (See 
Figure 1) is constructed in graph form; the various 
parameters to be evaluated are listed on the vertical 
axis, plotted against the horizontal time axis. The time 
scale has 24 divisions, enabling usage for a 24-hour pe- 
riod in the usual application (q1h craniotomy checks). 
These time divisions are unnumbered, however, so that 
observations may be recorded at any appropriate in- 
terval {e.g., q 15 min. x 6 hours, or q 2 x 48 hours), 
depending upon the requirements of the individual sit- 
uation and the physician's discretion. 

There are two major points of interest in viewing 
this new form. First, the various sets of clinical obser- 
vations are grouped in logical sequence, and standard- 
ized terminology is used which is specifically defined, 
where necessary, on the form itself. Also standard- 
ized, the evaluation symbols are either defined (See 
Figure 2), or keyed to examples which are printed 
on the sheet. 

Second, within each of five categories of evaluation, 
the single-choice options are listed in descending order 
with the most normal situation at the top, and the 
most abnormal at the bottom of the sequence. In the 
evaluation of the level of consciousness, for example, 
the five descriptive choices available to the observer 
begin with the normal state, "alert"; proceed through 
"lethargic," "stuporous," and "semi-coma"; and con- 
clude with the most abnormal state, "coma." 

Thus, at each unit of time, the observer {nurse, corps- 
man) is instructed to blacken a box corresponding to 
the observed patient response within each category. 
As the recording continues, these blackened boxes com- 
bine to form broad lines, the slope of which provides 
an immediate graphic representation — not only of the 
patient's status at that moment, but also of the pa- 
tient's course over the entire recording period, i.e., the 
trend. Thus, a straight line indicates a stable clinical 
course, a rising line suggests an improving or resolving 
condition, and a falling line denotes a deteriorating con- 
dition. If several lines are falling, for example, the 
clinical situation is obviously deteriorating. 

Muscle strength and pupillary size/reactions are re- 
corded in the standard manner indicated on the sheet. 

CONCLUSIONS 

The advantages of this check sheet are real. Whether 
they be nurses, corpsmen, or physician's assistants who 
do not have the clinical expertise of the neurosurgeon 
or neurologist, first-line personnel are now provided 
with a "yardstick" by which they may evaluate their 



INSTRUCTIONS 

1. Chart specific numbers for: Blood Pressure, Pulse, 
Respirations, and Temperature, in section labelled 
"Vital Signs." 

2. "Level of Consciousness" is determined by your 
observation and by the patient's response. 

Alert = awake and responsive {verbal and 

motor) 

Lethargic = sleepy or drowsy. Will awaken and 
respond appropriately to command. 

Stuporous = not awake, but will usually respond 
appropriately to light pain. 

Semi-Coma = not awake. Will respond purpose- 
fully to deep pain. 

Coma = unresponsive or decerebrate to any 

form of stimulation. 

3. "Strength": Record your estimate of patient's 
strength in response to command or pain: 

= no function 

1 = minimal function 

2 = approximately 14 normal strength 

3 = minimal weakness 

4 = normal 

GPO 863-198 



Figure 2.— Additional instructions appear on the reverse 
side of the Craniotomy Check Sheet. 



patient, not only in absolute {instantaneous) terms, but 
also in the more significant relative (evolutionary) terms 
which indicate a trend. In using this form, paramedical 
personnel will be less likely to miss ominous prognosti- 
cators. They will be more likely to appreciate the over- 
all clinical situation, not only in terms of "where the 
patient is" at any given moment, but "where he has 
been," and "where he is going." 

It is recognized that some may quibble with the 
given terminology, or the relative merits of incorpo- 
rating one or another clinical parameter into this form. 
Nevertheless, based upon satisfactory usage and wide- 
spread acceptance of the form by those personnel in- 
volved in the care of our neurosurgical patients, this 
check sheet is recommended for consideration by vari- 
ous Naval medical centers where neurology/neurosur- 
gery patients are treated.^ 



Volume 63, May 1974 



25 



Evaluation of Instruction for 

Hospital Corpsmen in Patient Care 



By LT Virginia M. Bousquet, NC, USiSJ, 
Hospital Corps School, Great Lakes, III. 



The hospital corpsman has for many decades cared 
for the sick and injured of our armed services, and their 
dependents. As nursing instructors, we must constantly 
modify and evaluate the patient-care instruction offered 
these young men and women in order that they may 
participate in, and be more responsible for the care of 
patients upon completion of their training program. 

Every week at Hospital Corps School, Great Lakes, 
til., 70 young men and women begin 14 weeks of in- 
tensive instruction in patient care, first aid, anatomy, 
physiology, preventive medicine, and pharmacology. 
While 70 students begin, an average of 54.6 students 
graduate weekly to serve in our many hospitals and 
dispensaries. 

During the 14-week period of instruction, only one 
and one-half weeks are spent in the hospital; the re- 
mainder of the instruction takes place in the classroom. 
Because so little time is spent in the clinical area, the 
classroom experience must be extremely meaningful and 
vivid. To help the students understand the material, 
we rely heavily on training aids and previous experiences 
of the instructors. 

Traditionally, a nurse has been assigned to the con- 
vening company as company nurse. In this role she is 
responsible for teaching patient care during the 14-week 
period. In addition, she serves as a counselor and parent 
surrogate. 

In an attempt to improve our patient-care instruction, 
we divided the six units of patient-care instruction 



The opinions and assertions expressed in the above article 
are those of the author and are not to be construed as neces- 
sarily reflecting official views of the Navy Department, or the 
naval service at large. 



among six instructors, instead of having one instructor 
teach in all of the areas. We then decided to evaluate 
the effectiveness of our unit instruction, by comparison 
with the older teaching method. 

Unit instruction offers the student an opportunity 
to work with six different nurses, a more realistic situ- 
ation which will be prevalent when the students leave 
school. In addition, the nurses offer a variety of ex- 
periences which add interest to the course material. 
Finally, it was hoped that improved unit instruction 
might be reflected in higher student grades as the nurses 
became progressively more familiar with their units, 
enhancing lessons, audiovisual aids, and their own teach- 
ing skills. 

A survey and analysis of available literature on teach- 
ing methods provided little information appropriate to 
our particular situation. Except for the much reiterated 
necessity to continually redefine the knowledge, judg- 
ment, and skills required for nursing personnel, and 
various methods of accomplishing this (from observation, 
to devising a systematic approach), few conclusions can 
be drawn. Reference to any measuring device which 
would effectively evaluate our students' performance 
could not be found. 



METHOD 

In order to evaluate the students' performance dur- 
ing 14 weeks with the same instructor, as compared 
with the performance of students taught by six different 
nursing instructors for 14 weeks, four companies hav- 
ing one instructor and eight companies having unit in- 
struction were selected for comparative study. 



26 



U.S. Navy Medicine 



The students selected for the study had to have be- 
gun their careers with the company convening week, 
and could not have been placed in an accelerated status 
because of previous hospital or medical experience ac- 
quired before entering the Navy. Students who had 
been set back were not used in the study, because of 
the many variables that are too difficult to control, 
which had been responsible for set-back action. The 
total sample involved 660 students. 

The companies were compared on the basis of their 
GCT/ARI scores — the military equivalent of the IQ 
test. Comparison of average GCT/ARI scores was made 
to determine if there were a significant difference be- 
tween the intelligence potentials of the 12 groups which 
might, alone, account for any improvement in student 
performance. (See Table I). 

Secondly, patient-care scores obtained by these 
students, under the two types of instruction were ex- 
amined, to determine if there had been any distinctive 
improvement in the student performance. (See Table II). 

Thirdly, the student-skill practices were addressed. 
Students demonstrated procedure skills in giving bed 
baths; measuring body temperature, pulse, respiratory 
rate, and blood pressure (TPR and BP}; and in applying 
surgical dressings. Demonstrated skills were evaluated 
on a four-point scale to determine if student performance 
had improved as the instructor gained experience in 
repeatedly demonstrating and setting up the skill prac- 
tice. 

These three particular phases of study deal with the 
only objective areas which we were adequately able to 
test. Though extremely subjective, the last or fourth 
area studied was the consensus of the nurses' own opin- 
ions, comments, and criticisms of unit instruction. The 
latter consideration served to solicit ideas for improv- 
ing the instructional experience of corpsmen, and for 
accepting or rejecting unit instruction as a concept of 
teaching. 



ANALYSIS OF DATA 

Examination of the GCT/ARI scores revealed a low 
company average of 106.24, and a high company average 
of 116.94. The average for the twelve companies was 
112.13. This indicated that no significant difference 
between the groups could account for improved per- 
formance on the basis of innate intelligence. Table I 
shows the distribution by companies. 

Secondly, analysis of the patient-care examinations 
was conducted to determine if an improvement in test 
scores, in a comparison between the two groups, could 
be demonstrated. (See Table II). 



TABLE 


I 


COMPARISON OF GCT/ARI SCORES FOR 


12 STUDENT GROUPS 


Company 


Average GCT/ARI Sc 


No. 


for Company Groi 


With Company Nurse 27 


116.94 


28 


110.64 


29 


112.22 


30 


106.24 


Average: 


111.51 



With Unit Instructors 



31 


115.11 


32 


115.97 


33 


1 1 2.90 


34 


109.00 


35 


1 1 1 .46 


36 


113.12 


37 


113.00 


38 


108.96 



Average: 



112.44 



TABLE II 
COMPARISON OF PATIENT CARE (PC) SCORES 




PC No.1 


PC No.2 


PC No.3 


PC No.4 


PC No.5 


Company 

Nurse 


87.23 


81.82 


82.38 


83.17 


80.92 


Unit Instruc- 
tors 


89.15 


84.49 


85.33 


83.13 


83.83 



From a study of Table II one can appreciate the 
consistent improvement demonstrated in all patient- 
care (PC) tests of students who received unit instruction, 
except in the case of PC No.4, where company-nurse 
instruction had a slight advantage. On the whole, stu- 
dents definitely improved under the unit-instructors 
concept. PC No.3 and No.5 were significant at the 
0.05 level. 

Another subjective aspect of consideration was that 
of eliciting student opinion as to whether they prefer- 
red having one instructor for 14 weeks, or the six in- 
structors encountered in unit teaching. Students were 
cautioned that personalities should not be allowed to 
enter into their decision. This not only allowed stu- 
dents an opportunity to express their individual feelings 
but, since they were the recipients or our instruction. 



Volume 63, May 1974 



27 



their preference for a particular method of instruction 
could be germane to the effectiveness of that method. 
Thirdly, skill practices were examined to determine 
if student performance increased as instructors gained 
experience in demonstrating skills through repetition. 
It was felt that repetition became an important factor 
when we consider that the company nurse teaches each 
skill once in 14 weeks, while the unit instructor repeats 
each skill every two weeks. To emphasize the importance 
of having the instructor repeat teaching of skills at 
frequent intervals, we divided the unit instruction into 
two parts. It was considered that the first four com- 
panies would have had instructors who had not per- 
formed these skills in a period of 8-14 weeks. The next 
four companies had instructors who had repeated these 
teaching skills during the previous four weeks. If our 
contention is correct, that instructor performance im- 
proves with practice, then student performance should 
also show improvement. Table III reveals the data ob- 
tained, utilizing a four-point scale for grading specific 
skills. 





TABLE III 








COMPARISON OF DEMONSTRATED STUDENT SKILLS 


Student Groups 


Bed bath 


TPR 


BP 


Surgi 


cal Dressing 


Company Nurse 


2.2 


2.3 


2.2 




2.2 


Unit Instructors, 












Co. 31-34 


2.5 


2.4 


2.7 




2.3 


Unit Instructors, 












Co. 35-38 


2.6 


2.7 


2.6 




,4 



As can be seen in Table III, significant improvement 
can be demonstrated in the first two skill practices in 
a comparison between the company nurse and the unit- 
instructor methods of teaching, and the performance 
levels of students tend to improve as the instructors 
repeat the teaching of skills, in all areas but blood- 
pressure measurement. 

The last phase of study addressed the instructors' 
own opinions of the two methods of instruction. The 
only definite information obtained indicated that in- 
structors were either very much for, or very much 
against a particular method. The greatest complaint 



lodged against unit instruction by the nurses was that, 
because of the short time they are permitted with each 
student, an average period of one to three weeks, they 
simply cannot get to know each student and thus can- 
not effectively ascertain specific abilities or lack of 
ability. All nursing instructors acknowledge that grades 
do not necessarily determine how effectively a student 
will care for patients. 

The student-opinion survey as to which method of 
instruction they preferred showed that 68% favor unit 
instruction, 20% are opposed to unit instruction, and 
11% have no preference. 



CONCLUSIONS 

Although this study does demonstrate a marked im- 
provement in selected phases of student performance 
achieved by unit instruction, when compared with stu- 
dent performance following instruction by a single com- 
pany nurse, this, in itself, is not the most important 
revelation. A more significant feature is that education 
can and must undergo change. Evaluation of the re- 
sults of change should determine its effectiveness. The 
effects will be reflected in student performance, and 
more specifically, in the student ability to care for pa- 
tients. 

The large unit of data gathered for this study at 
Hospital Corps School Great Lakes, will be the subject 
of further investigation and exploration. Are we teach- 
ing what the student really needs to know, for ex- 
ample, in order to care for patients effectively? Sec- 
ondly, are the students motivated to a greater extent 
when instructed by six nurses, rather than one? Finally, 
can we predict before a student begins this intensive 
course whether or not he will succeed? 



SELECTED REFERENCES 

1. Lonberteen E: Changes in practice require changes in 
education. Am J Nurs 66:1784-1788, Aug 1966. 

2. Rudhen G and HamisterS: Evaluation of a training pro- 
gram for nursing assistants. Nurs Outlook 21:404-407, Jun 1973, 

3. Krueger G: Training nursing assistants for a sub- 
professional role. Ment Hyg 54:152-154, Jan 1970.t? 



28 



US. Navy Medicine 



The Endodontic Significance of the 
Mesiobuccal Root of the Maxillary First Molar 



By LT Frank J. Vertucci, DC, USNR, 
Endodontist, Dental Department, 
Naval Station Mayport, Jacksonville, Fla. 



Dentists have been treating maxillary first molars 
endodontically for years under the general assumption 
that these teeth have three root canals. However, de- 
spite the excellent overall success rate for endodontic 
cases, the mesiobuccal root of the maxillary first molar 
has always carried an excessively high failure rate. This 
has been due to the frequent occurrence of a second 
separate canal in this root, which is rarely located and 
filled. Consequently, a thorough knowledge of root- 
canal anatomy is essential for ultimate endodontic suc- 
cess. 

Our current concept of root-canal morphology is 
based upon the exhaustive work of Hess, 1 who made 
vulcanite corrosion preparations of 3,000 permanent 
teeth. Of 513 maxillary first and second molars, Hess 
found 46% with three canals and 54% with four canals. 
Many authors^AEi c j te these frequencies when report- 
ing on root-canal anatomy. However, these results are 
inaccurate because Hess incorrectly considered the 
maxillary first and second molars to be identical. 

Although the occurrence of two root canals in the 
mesiobuccal root of the maxillary first molar is men- 
tioned in most endodontic and dental anatomy text- 
books, words such as "may have," "occasionally," or 



The opinions or assertions contained herein are those of 
the author and are not to be construed as official, or reflecting 
the views of the Navy Department or the naval service at large. 

References to commercial supplies and sources are intended 
to serve reader convenience, and do not imply product endorse- 
ment by the US. Navy or the naval service at large. 



"infrequently" are employed; often the possibility of 
two canals is not even mentioned. Reports of recent 
investigations®' 7 ' 8 ' 9 indicate that the incidence of two 
canals at the apex of this root ranges from 14 to 42%. 
Since the literature is so inconclusive and variable, and 
since the maxillary first molar is endodontically one of 
the most commonly treated teeth, it was decided to 
conduct a detailed investigation of the morphology of 
the root canals of the mesiobuccal root of the extracted 
human maxillary first molar. From the various methods 
advocated for the anatomic examination of root canals, 
a standardized technique utilizing transparent specimens 
was selected. 



METHOD AND MATERIALS 

One hundred maxillary first molars were decalcified 
in 5% hydrochloric acid. Upon completion of this pro- 
cess, the teeth were washed in tap water and placed in 
5% potassium hydroxide solution for 24 hours. They 
were then injected with hematoxylin dye, and dehy- 
drated in successive solutions of 70%, 95%, and absolute 
alcohol for periods of five hours each. Finally, the 
specimens were placed in crystal-clear liquid plastic 
casting resin,* and were completely cleared within 12 
hours. 



•Fibre-Glass-Evercoat Co., Inc.; Cornell Rd., Cincinnati, 
Ohio. 



Volume 63, May 1974 



29 



RESULTS 



DISCUSSION 



The transparent specimens were examined under the 
dissecting microscope, and the following features were 
recorded: the number and types of root canals, the 
number and location of apical foramina and transverse 
anastomoses, and the frequency of apical deltas. These 
data are summarized in Tables I and II. 



TABLE I 



CLASSIFICATION AND INCIDENCE OF 

MESIOBUCCAL ROOT CANAL TYPES IN 

THE MAXILLARY FIRST MOLAR 


Canal 
Configuration 


Type 1 


Type II 


Type III 


1 ncidertce 
(percent) 


45 


37 


18 



The canal configurations of the mesiobuccal root of 
the maxillary first molar can be classified into the fol- 
lowing three types: 

Type I — A single canal from the pulp chamber 

to the apex 
Type II — Two separate canals leaving the pulp 
chamber, but joining short of the apex 
to form one canal 
Type III — Two separate and distinct canals, from 
the pulp chamber to the apex 
Of the 100 teeth studied, 45% had a Type I con- 
figuration, 37% possessed a Type II configuration, and 
18% showed a Type III configuration. 



Considering Type I and Type M cases together, it is 
noted that 82% of the roots displayed a single apical 
foramen. If the single canal in Type I cases, and one 
of the two canals in Type II cases were treated end- 
odontically, and were properly instrumented and filled, 
the chance of success would be excellent. This is 
because of the low incidence of apical deltas and col- 
lateral ramifications in these situations. Nevertheless, 
it is in the best interest of the patient that the dentist 
fill as many of the canal spaces as can be found clini- 
cally. 

All Type II cases consisted of a larger buccal canal 
and a smaller canal located palatal to the former, 
which merged at a point located from one to four mm 
from the apex. These situations are best treated by 
instrumenting, filling the buccal canal to the apex, and 
filling the palatal canal to the point where it joins the 
buccal. This is because the buccal canal is the one with 
straight-line access to the apex. 

In all Type III cases, both canals must be adequately 
sealed in order to achieve success. It was interesting 
to note that both canals do not always terminate at 
the same level in the root. The more buccally placed 
canal is always larger and wider, whereas the more 
palatally situated canal is shorter and narrower, and 
may, in fact end in the middle-third of the root. This 
is due to the fact that in certain instances the mesio- 
buccal root tends to bifurcate, thereby displaying two 
root apices which resemble the situation presented in 
the mesial root of the mandibular first molar. The re- 
lationship must be remembered when one fills these 
canals because it is difficult to see, in a roentgenogram, 
a second canal in the mesiobuccal root of maxillary 



TABLE II 





MORPHOLOGY OF THE MAXILLARY FIRST MOLAR MESIOBUCCAL ROOT 




Position of 




Position of 


Position of 






1 Lateral Canals 




Transverse 


Apical 




Number 
of 




Transverse 
Anastomosis 


Anastomosis 


Foramen 


Apical 


















Deltas 


Teeth 


Lateral 
Canals 


Cervica 


-o 

i 


-^ | between 

o. Canals 
< 


to 
5 

£ 

Q) 

o 


CD 

■a 

I 


(U 

o 

'5. 

< 


C 
0) 


to 

La 

n> 

4-* 

CO 

_l 




100 


" 


13 


16 


71 52 


10 


75 


15 


24 


76 


8 



30 



U.S. Navy Medicine 



molars. This is due to the very small width of the 
second canal, and its close proximity to the larger canal. 
Consequently, to accomplish proper filling of the more 
palatal canal, one has little more than the patient's pain 
reaction for use as a guide. Furthermore, because of 
the high incidence of two canals in this root, wisdom 
would dictate a greater opening of the access cavity 
toward the mesial aspect in order to facilitate the search 
for the second canal. Its orifice is usually found just 
palatal to the orifice of the main mesiobuccal canal. 

Sometimes failures of treatment occur despite rigid 
adherence to basic treatment principles. 10 When either 
pain or periapical breakdown is noted following ap- 
parently effective endodontic treatment, the possible 
presence of a second canal should be considered before 
the tooth is condemned, or surgical intervention is 
scheduled. If an apicoectomy and reverse fill become 
necessary, a complication may arise if a bifurcated 
canal is present; surgery may cause a single apical 
foramen ultimately to become two separate foramina. 
Results will be poor if the second canal is not routinely 
looked for at the time of surgery, owing to the high 
incidence of double canals in this tooth. Once the 
dentist becomes aware of the tendency for bifurcated 
and double canals to occur in the mesiobuccal root of 
the maxillary first molar and the possible added com- 
plications of apicoectomy, endodontic procedures on 
this root will ultimately be more successful. 



SUMMARY 

One hundred maxillary first molars were decalcified, 
injected with dye, cleared and studied. The canal con- 
figurations of the mesiobuccal root were categorized as 



follows: 45% had a single canal, 37% presented two 
canals which merged toward a single apical foramen, 
and 18% exhibited two distinct canals with separate 
apical foramina. A knowledge of these variations will 
assist the dentist in reaching proper conclusions in the 
diagnosis and treatment of endodontic cases. 



REFERENCES 

1. Hess W: Anatomy of the Root Canals of the Teeth 
of the Permanent Dentition. Part I, pp 32-35, New York, 
William Wood & Co, 1925. 

2. Mueller AH: Morphology of root canals. J Am Dent 
Assoc 23:1698-1706, 1936. 

3. Green D: Morphology of the pulp cavity of the per- 
manent teeth. Oral Surg 8:743-759, 1955. 

4. Skillen WG: Morphology of root canals. J Am Dent 
Assoc 19:719-735, 1932. 

5. Sommer RF, Ostrander FD and Crowley MC: Clinical 
Endodontics. 3rd ed, p5, Philadelphia, WB Saunders Co, 1966. 

6. Weine FS, Healey HJ, Gerstein H and Evanson L: Canal 
configuration in the mesiobuccal root of the maxillary first 
molar and its endodontic significance. Oral Surg 28:419-425, 
1969. 

7. Dornelles P: Consideracoes anatomicas sobre a con- 
formacao interna da raiz mesiovestibular do primeiro molar 
superior permanente. Rev Gaucha Odontol 7:35-38, 1959. 

8. Pineda F: Roentgenograph^ investigation of the 
mesiobuccal root of the maxillary first molar. Oral Surg 36: 
253-260, 1973. 

9. Green D: Double canals in single roots. Oral Surg 
35:689-696, 1973. 

10. Seltzer S and Bender IB: Cognitive dissonance in 
endodontics. Oral Surg 20:505-516, 1965.$ 



MEDICAL AUDIT SYSTEM STUDIED 
AT TWO NAVAL HOSPITALS 



Naval Hospitals Pensacola, Fla„ and Portsmouth, Va., will participate in a pilot study of a com- 
puterized medical-care-audit system. The study will begin 1 Apr 1974. It is designed to provide the 
Navy Bureau of Medicine and Surgery with information which will be used to study hospital practice, 
and to evaluate the quality of care as reflected in medical records and review utilization. 

The two hospitals will use the Professional Activity Study — Medical Audit Program system spon- 
sored by the Ann Arbor, Mich., Commission on Professional and Hospital Activities. 

The purpose of the Professional Activity Study is to provide an overall display of hospital practice 
from a one-sheet abstract of information contained in medical records submitted by participating hos- 
pitals. Medical Audit Program reports submitted by the hospitals will aid in auditing medical care and 
defining continuing medical education needs. — PAO, Nav Aerosp and Reg Med Cen, Pensacola, Fla.? 



Volume 63, May 1974 



31 



An Outbreak of Respiratory Disease 
Misdiagnosed as an Adverse Drug 
Reaction in a Naval Recruit Population 



By CAPT D.F. Hoeffler, MC, USN,tt 
E.J. Sullivan,* and 
CAPT C.H. Miller, MC, USN.T 



Benzathine penicillin G (Bicillin) is one of the most 
commonly used penicillin derivatives. It is frequently 
administered parenterally in a dose of 1.2 million units 
as prophylaxis against streptococcal infection and re- 
current attacks of rheumatic feverJ Reported adverse 
responses to benzathine penicillin G include anaphy- 
laxis, morbilliform and urticarial skin eruptions, serum 
sickness, and pain at the injection site.^'4 The inci- 
dence of all toxic and allergic reactions to the penicil- 
lins is estimated to be in the range of 1-8% depending 
on the penicillin derivative prescribed, the duration of 
drug usage, and the population studied.^" 7 

Prophylactic penicillin has been used routinely at 
the Recruit Training Command, Great Lakes, III., since 
the late 1950s, and has been shown to be of value in 



tCommanding Officer, Naval Medical Research Unit 
(NAMRU) No. 4. 

ttExecutive Officer/Director, Scientific Department, 
NAMRU No. 4. 

*NAMRU No. 4, Great Lakes. Illinois 60088. 
The opinions and assertions contained in the above arti- 
cle are those of the authors and do not necessarily reflect the 
official views of the Bureau of Medicine and Surgery, the Navy, 
Department, or the naval service at large. 



aborting seasonal epidemics of streptococcal disease." 
Naval recruits receive benzathine penicillin G intramus- 
cularly during their second week of training provided 
they have no history of penicillin allergy. The reported 
incidence of benzathine penicillin G reactions in these 
young men is estimated at about 1 %. 

We had previously suspected that many nonallergic 
recruits were being diagnosed as "allergic to Bicillin" 
without an adequate medical justification. An epidemic 
of "Bicillin reactions" in two recruit companies led us 
to investigate other possible etiologies for the observed 
symptoms. This paper reports the findings of that in- 
vestigation, and suggests that the alleged "Bicillin reac- 
tions" were due to an epidemic of acute respiratory 
disease (ARD). 

BACKGROUND 

The Recruit Training Command, Great Lakes, III., is 
one of the Navy's three recruit-training facilities. Young 
men reporting there for training range in age from 17- 
22 years. For the most part they are natives of the 
northeastern and midwestern United States. The re- 
cruits are assigned to companies, each of which is 



32 



US. Navy Medicine 



composed of 50-70 men. Paired companies, known as 
"sister companies" are berthed in adjoining open-bay 
barrack compartments. The first week of training is 
devoted to military orientation, medical-dental screen- 
ing, and mental and physical evaluation. During this 
period trainees receive diphtheria-tetanus, influenza, 
group C meningococcus, and types 4 and 7 adenovirus 
vaccines. At the end of the second week of training, 
recruits without a history of penicillin allergy are given 
1.2 million units of benzathine penicillin G intramus- 
cularly. 

Previous studies have shown that recruits have a 
marked prevalence of acute respiratory disease (ARD) 
with a peak incidence during the first four weeks of 
training. "'10 |t has been further observed that more 
than 20% of recruits may have rhinovirus and adeno- 
virus infections during the first week of training. 
Streptococcal infection, as judged by positive throat 
cultures occurs in 1.1% of incoming recruits, and in 
0.5% of recruits who are graduating. '^ 

MATERIALS AND METHODS 

Study Population. In late June, 1973, the Field 
Laboratory, Naval Medical Research Unit (NAMRU) 
No. 4 notified the Epidemiology Division that a large 
number of acutely ill men were reporting to sick call 
from two "sister companies." The recruits' symptoms 
occurred 24 hours after the two companies had re- 
ceived their benzathine penicillin G injections, and 
were thought to be due to an adverse drug reaction. 
There were 56 men in the first company and 58 men 
in the second. A questionnaire was used to determine 
the incidence of symptoms among all 114 men, and the 
presence or absence of fever (oral temperature greater 
than 100°F) was recorded. A systematic sample of 10 
men from each company was selected for laboratory 
evaluation. These 20 men had clinical symptoms repre- 
sentative of those experienced in the total population 
of the two companies. 

Virus Isolation. Specimens were collected within 36 
hours of the onset of clinical symptoms. Throat swabs 
were obtained from each of the 20 men in the sample 
population. Rectal swabs were collected from all ten 
men in the first company, and from six of ten men in 
the second. The specimens were immersed in veal in- 
fusion broth (Difco) supplemented with 0.5% bovine 
albumin. Aliquots were inoculated into duplicate tubes 
containing HeLa and primary rhesus monkey kidney 
cell cultures. One set of tubes was incubated stationary 
at 36°C, and the other rolled at 33°C. Two 14-day 
passes were completed before a specimen was desig- 
nated as negative. Adenoviruses isolated in HeLa cells 



were typed by microtechnique, 13 using 20 antibody 
units of hyperimmune rabbit serum. Throat swab spec- 
imens that yielded adenovirus were treated with 50 
antibody units of hyperimmune type-specific rabbit 
sera to detect the presence of rhinovirus upon reinocu- 
lation. Enteric-like agents isolated from throat swabs, 
in HeLa cells rolled at 33°C, were passed until suffi- 
cient virus was present to give a 4+ cytopathogenic 
effect within 48-72 hours. These virus pools titrated 
1 x 10 4 , or greater per ml, and were used in all identi- 
fication tests. Acid sensitivities were determined in 
microplates using pH 3.0 and 7.0 buffers. 14 The tests 
were evaluated at three and six days, when the cyto- 
pathogenic effect in control buffer {pH 7.0) was com- 
plete. A 2 log^Q reduction in titer, in pH 3.0 buffer, 
was considered indicative of acid lability and charac- 
teristic of rhinovirus-like organisms. Standard methods 
used to differentiate H and M strain rhinoviruses indi- 
cated that the isolates belonged to the H group. The 
isolates were then typed by microplate neutralization 
tests using 32 — 100 tissue culture infective doses 
(TCID) 50 of virus against 10-20 antibody units of hy- 
perimmune bovine and guinea-pig serum. Antisera to 
41 rhinovirus types were available. 

Serology. Blood specimens were obtained at the 
time of the initial interview. A second specimen was 
drawn three weeks later. Fifteen matched pairs of sera 
were available for evaluation. Complement fixation 
tests were performed on all specimens using adenovirus 
group antigen. Paired sera were also tested against the 
rhinovirus isolates using homologous and heterologous 
neutralization techniques. The neutralization tests were 
done in microplates using HeLa cells. Serologic evalu- 
ations were made when virus back titrations were re- 
corded between eight and 16 TCIDgQ. Men from whom 
no rhinovirus was isolated were similarly examined for 
the presence of rhinovirus antibodies. A fourfold, or 
greater rise in complement fixation or neutralization 
antibody titer, between the initial and subsequent se- 
rum specimen, was interpreted as serologic evidence 
of infection (seroconversion). 

RESULTS 

Clinical. Clinical symptoms were present in 100% 
of the men in both companies. Similar illness was re- 
ported by the company commanders and their assis- 
tants, none of whom had received benzathine penicillin 
G. Table I summarizes the clinical symptoms reported 
by the companies. The data are distributed similarly 
in both groups of men, and suggest an epidemic of 
acute respiratory disease (ARD) rather than an unto- 
ward drug response as was originally suspected. 



Volume 63, May 1974 



33 



TABLE I 

DISTRIBUTION OF CLINICAL SYMPTOMS AMONG TWO COMPANIES OF NAVY 
RECRUITS FOLLOWING A SINGLE INJECTION OF BENZATHINE PENICILLIN G 



Symptom 


Company 1 (n = 56} 
Number Percent 


Company 
Number 


2 (n = 58} 
Percent 


Fever 


29 


52 


24 


41 


Headache 


34 


61 


35 


60 


Myalgia/Arthralgia 


50 


89 


50 


86 


Vertigo/Dizzy 


35 


63 


40 


69 


Sore Throat 


36 


64 


34 


59 


Cold/Runny or Stuffy Nose 


36 


64 


50 


86 


Nausea 


7 


12.5 


3 


5 


Diarrhea 


9 


16 








Soreness of Injection Site 


56 


100 


58 


100 


Urticaria/Morbilliform Eruption 















Virus Isolation. The isolation data for the 20-man 
sample are detailed in Table II. Adenovirus was recov- 
ered from the throat of two recruits, and from the 
rectum in nine recruits. Rhinovirus was isolated from 
13 throat swabs. As would be expected, no rectal iso- 
lates of rhinovirus were obtained. Although some het- 
erologous crossing occurred with the bovine antisera 
to rhinovirus types 3, 5, 31, 32 and 42, all the isolates 
proved to be serologically like rhinovirus type 14. 

Serology. The summary of the serologic findings on 
15 pairs of sera are seen in Table III. No antibody 
rises to adenovirus were seen in the complement fixa- 
tion tests. Ten of 13 recruits with rhinovirus isolates 
seroconverted to their homologous viral isolate. Ex- 
tensive heterologous rises indicated that the infecting 
viruses were of a common type. Serum pairs were 
available in five of the seven patients from whom no 
rhinovirus was recovered. In three of these, serocon- 
version to one (or more} rhinovirus isolate was noted. 
The remaining two patients had preexisting antibodies 
to rhinovirus. 

In collating the laboratory data we note that 13 of 
15 (86%) pairs of sera showed heterologous rises to 



rhinovirus isolates prevalent in the sample population. 
Rhinovirus was recovered from the throat of 10 of 
these 13 men. Three men from whom rhinovirus was 
not recovered also seroconverted to type 14 virus. 
There were no seroconversions to adenovirus in the 
men studied. 

DISCUSSION 

This paper recounts an incident in which the mani- 
festations of an acute respiratory illness among naval 
recruits were mistaken for an adverse reaction to peni- 
cillin. The clinical and laboratory findings presented 
support the hypothesis that the symptoms were prob- 
ably due to rhinovirus (type 14) infection. Recovery 
of adenovirus from the throat of two men in the sample 
population may indicate that they were in the early 
stages of infection with wild strains of that agent. Rec- 
tal adenovirus isolates would be expected in this group 
of men since they had been recently immunized with 
live oral attenuated adenovirus vaccine. 15 The failure 
of any member of the study group to seroconvert to 
adenovirus, however, makes it unlikely that this agent 



34 



U.S. Navy Medicine 



TABLE II 

VIRUS ISOLATES FROM THROAT AND RECTAL SPECIMENS, IN SAMPLE GROUPS 
FROM TWO COMPANIES OF NAVAL RECRUITS, FOLLOWING A SINGLE INJECTION 
OF BENZATHINE PENICILLIN G 





Specimen 






Adenovirus 


Rhinovirus & 


No 


Company 


Source 


Number 


Rhinovirus 


4 7 4&7 


Adenovirus 


Isolate 
















1 


Rectal 


10 





4 1 1 





4 


2 


Rectal 


6 





2 1 





3 


1 


Throat 


10 


7 








3 


2 


Throat 


10 


6 


2 





2 



TABLE III 

THE SEROCONVERSION AND VIRUS ISOLATION DATA ON SAMPLE GROUPS 
FROM TWO COMPANIES OF NAVAL RECRUITS WHOSE SYMPTOMS WERE 
ALLEGEDLY DUE TO A SINGLE INJECTION OF BENZATHINE PENICILLIN G 



Serologic 
Category 




Virus G 


'oup Category 




Rhinovirus 
Isolates 
(n=5) 


Adenovirus 
Isolates 
(n=2) 


Adenovirus & 
Rhinovirus 
Isolates 
(n = 8) 


Neither Virus 
Group Isolated 












Rhinovirus 
Seroconversion 
(n = 13) 


2 


1 


8 


2 


Adenovirus (CF) 
Seroconversion 
(n = 0) 














Did not seroconvert 
to adenovirus or 
to rhinovirus 
(n = 2) 











2 


Paired sera not 
available for 
examination 
<n = 5) 


3 


1 





1 



Volume 63, May 1974 



35 



was responsible for the clinical illness observed in the 
two companies. 

It is important for medical personnel who see re- 
cruits to accurately differentiate between acute respira- 
tory disease (ARD) and untoward reactions from vac- 
cines and medications. The unjustified diagnoses of 
"penicillin allergy" among recruits ill with ARD pre- 
clude future use of the penicillins in the allegedly sen- 
sitive individuals. Further, the diagnoses are recorded 
in the servicemen's health records, and are mistakenly 
counted among the new allergic incidents in the medi- 
cal statistics of the Navy. 

Allergic and toxic side effects of the penicillins in- 
clude anaphylaxis, maculopapular rashes, urticaria, se- 
rum sickness, gastrointestinal upsets, and toxic bone 
marrow responses. Respiratory manifestations are not 
usually associated with penicillin reactions. ^"° 

In refining one's diagnostic technique it may be of 
use to recall that Navy recruits exhibit a high incidence 
of ARD during the first four weeks of training, and that 
these illnesses occur at a time when routine immuniza- 
tions and penicillin prophylaxis are being administered. 
A high index of suspicion on the part of physicians 
and hospital corpsmen, and awareness of the unique 
epidemiologic environment of the recruit camp will be 
helpful in more accurately separating adverse drug and 
vaccine responses from acute respiratory disease. 

SUMMARY 

Two companies of Navy recruits were investigated 
following reports that they had exhibited a high inci- 
dence of "allergic" reactions following an injection of 
benzathine penicillin G for streptococcal prophylaxis. 
Both companies were given a medical questionnaire, 
and ten symptomatic men from each company were 
sampled for virus isolation. Fifteen paired sera from 
these 20 men were evaluated for virus seroconversions. 
The clinical symptoms, and the frequency of rhinovirus 
isolation and seroconversion in the sample, supported 
the authors' hypothesis that this outbreak of "drug re- 
actions" was due to an epidemic of acute respiratory 
disease. The unsupported diagnosis of penicillin allergy 
may unjustly preclude the future use of these drugs in 
allegedly sensitive individuals. Medical personnel should 
be wary of making overly hasty appraisals of "adverse 
drug reactions" among naval recruit populations. 

Acknowledgment: 

The authors wish to express their appreciation to 
Dr. M.J. Rosenbaum and the Virology Division of 
Naval Medical Research Unit No. 4, and to Mrs. Ruth 
Bonovich, for their aid in preparing this article. 



REFERENCES 

1. Fendrick GM: Streptococcal Sore Throat, in Current 
Therapy. 24:131. Philadelphia, WB Saunders Co, 1972. 

2. Goodman LS and Gilman A: The Pharmacologic Basis 
of Therapeutics. 4th ed, pp 1225-1229, New York, Macmillan 
Co, 1971. 

3. Bernstein SH and Houser HBr Sensitivity reactions to 
an intramuscular injection of benzathine penicillin, IM Engl J 
Med 260:747-751, 1959. 

4. Rudolph AH and Price EV: Penicillin reactions among 
patients in venereal disease clinics. JAMA 223:499-501, 
1973. 

5. Von Arsdel PP Jr: The risk of penicillin reactions. 
Ann Intern Med 69:1071-1072, 1968. 

6. Smith JW, Johnson JE and Cluff LE: Studies on the 
epidemiology of adverse drug reactions. II. An evaluation of 
penicillin allergy. N Engl J Med 274:988-1002, 1966. 

7. Idsoe O, et al. Nature and extent of penicillin side- 
reactions with particular reference to fatalities from anaphy- 
lactic shock. Bull WHO 38:159-188, 1968. 

8. McFarland RB, Colvin VG and Seal JR: Mass prophy- 
laxis of epidemic streptococcal infections with benzathine pen- 
icillin G. II. Experience at a Naval Training Center during 
winter of 1956-57. N Engl J Med 258:1277-1284, 1958. 

9. Trautwein C and Edwards EA: Multiple Infections in 
Acute Respiratory Diseases. III. Natural Immunity to and in- 
terdependence of Eleven Etiological Agents in Naval Recruits: 
An Analysis of Serological Data. NAVMEDRSCHU-4 Research 
Project MF12.524.009-4013BE6I, Bureau of Medicine and 
Surgery Report (RU 72.3), Apr 1972. 

10. Edwards EAand Rosenbaum MJ: Surveillance Program 
1964-70. NAVMEDRSCHU-4 Research Project MF 12.524.009- 
4013BE6I, Bureau of Medicine and Surgery Report (RU 71.8), 
May 1971. 

1 1. Rosenbaum MJ, et al: Epidemiology of the common 
cold in military recruits with emphasis on infections by rhino- 
virus types 1A, 2, and two unclassified rhinoviruses. Am J 
Epidemiol 93:183-193, 1971. 

12. Peckinpaugh RO and Miller CH: NAVMEDRSCHU-4 
Annual Progress Report to The Commission on Acute Respira- 
tory Disease, Armed Forces Epidemiological Board, p 8. Navy 
Department, Bureau of Medicine and Surgery, 1972. 

13. Sullivan EJ and Rosenbaum MJ: Isolation and iden- 
tification of adenoviruses on microplates. Appl Microbiol 22: 
802-804, 1971. 

14. Rosenbaum MJ, Sullivan EJ and DeBerry P: Use of 
HeLa cells for the laboratory diagnosis of rhinovirus infections. 
Bacteriol Proc, V264, 1970. 

15. Rosenbaum MJ, DeBerry P, Sullivan EJ, et al: Char- 
acteristics of vaccine-induced and natural infection with adeno- 
virus type 4 in naval recruits. Am J Epidemiol 88:45-54, 
1968.1? 



36 



U.S, Navy Medicine 



MEDICAL STUDENT RECRUITING: 
Past, Present and Future 



By CAPT Matt Backer, MC, USNFT 



In May 1971, at a Reserve Forces Policy Board Sem- 
inar conducted at the Pentagon, an Army Major Gen- 
eral asked a young Air Force physician the following 
question: "Doctor, when the draft ends, how are the 
Armed Forces going to get physicians?" To this the 
young man from Arkansas replied, "Ginral, you ain't 
gonna' get any." Though the young man may have 
been given to hyperbole, it can hardly be gainsaid that 
physician procurement will provide a challenge. 

THE PAST 

It is germane to the present problem to consider past 
efforts at recruiting medical officers for the Navy, much 
of which has been exerted at the student level. Table I 
chronicles past efforts. 

As far back as World War I there was an Enlisted 
Medical Reserve Corps which medical students could 
join, allowing for completion of their medical educa- 
tion, with the understanding that they would subse- 
quently serve on active duty in the Navy as physicians. 
We are unable to find much else recorded about medi- 
cal recruiting until 1940, at which time the Ensign 
HV-P Program was begun; it also offered immunity to 
conscription while in medical school, contingent upon 
subsequent active Naval service. 

In early 1943 the Medical V-12 Program was begun, 
in which medical students were placed on active duty 
as Apprentice Seamen, V-12. Their tuition and fees 
were paid, as was a very small stipend; they wore a 
midshipman-type uniform, and upon graduation they 



*101 Flamingo Drive, St. Louis, Mo. 63123. 

The opinions and assertions contained in the above article 
are those of the author, and are not to be construed as official 
views of the Bureau of Medicine and Surgery, the Navy Depart- 
ment, or the naval service at large. 

As a highly productive and enthusiastic physician in the 
Naval Reserve, CAPT Backer's views and analysis of medical stu- 
dent recruiting should be of considerable interest to our readers. 



were commissioned as lieutenants (jg). Medical Corps, 
USNR. It is of interest that many medical students 
around the country did, in fact give up their commis- 
sions as Ensigns HV-P, and reverted to enlisted status 
in order to take advantage of the tuition subsidy. 
Some V-12 students served on active duty before the 
end of World War II, but others did not finish school 
by that time. Many of the latter were called to active 
duty during the Korean conflict, in repayment for the 
deferment and tuition received. 





TABLE 1 


PAST OFFICIAL DOCTOR-PROCUREMENT 


EFFORTS 




Year of Origin 


Program 


1918 


Enlisted Naval Reserve Corps 


1940 


Ensign HV-P Program 


1943-1946 


Medical V-12 Program 


1946 


Ensign HP Program 


1950 


Doctor Draft began 


1952 


Ensign 1995 Program 


1957 


Commandant Representatives 




appointed 


1958 


Senior Medical Student Program 


1959 


Commandant Representatives 




Seminar began 



Volume 63, May 1.974 



37 



In 1946 the Ensign HP (Hospital Corps, Probation- 
ary) program was launched, thereby offering a proba- 
tionary reserve commission to students in good stand- 
ing, in any Class A medical school. The program made 
it possible for ex-V-12 students, and people who had 
had World War II service, to continue reserve participa- 
tion. No tuition or stipend was included, nor was any 
active duty for training during the medical school years 
involved. Participants without prior active duty were 
required to serve two years of subsequent service as an 
active-duty doctor. 

It is important to note that legislation existed from 
1950 until 1 July 1973, which permitted the drafting 
of doctors into the armed forces; during the years 
1958-60 and 1968-69, however, there were no doctors 
drafted. More than 5,000 physicians have been drafted 
into Naval service since 1954, and it goes without say- 
ing that many, many more entered various Navy medi- 
cal programs under the threat of being drafted. It is 
also evident that the Navy has acquired significant 
numbers of doctors via the draft in other years (See 
Table II). 

In the early 1950s the Ensign HP program was re- 
designated the Ensign-) '995 program, and summer duty 
was made available. After the Korean conflict, how- 
ever, there was little interest in the program. In 1954 
it became necessary for the Navy to take 1,080 men 
from the selective service pool. {See Table II) 





TABLE 


II 




DRAFTED PHYSICIANS ASSIGNED TO THE 


NAVY SINCE 1954 






Year 


Number 


Year 


Number 


1954 


- 1,080 


1964 


- 325 


1955 


200 


1965 


- 320 


1956 


680 


1966 


- 662 


1961 


105 


1967 


- 657 


1963 


250 


1971 


- 531 



In 1957, RADM Bartholomew Hogan, MC, USN, 
then Surgeon General, conceived the idea of appointing 
reserve medical officers as Navy Commandant's Repre- 
sentatives at medical schools throughout the country. 
Their task was to improve the image of Navy medicine 




RADM Bartholomew W. Hogan, MC, USN 
Surgeon General, 1955-1961 



at the local level, and to sell the Ensign Medical pro- 
gram. Admiral Hogan also secured for Navy medical 
officers a number of advantages which were to improve 
the Corps as a career. Among these were the profes- 
sional pay differential, the assurance of 20-year retire- 
ment if requested, and constructive credit allowance 
for medical school and intern years to allow earlier 
promotion to the rank of lieutenant senior grade. It is 
also fair to say that under his aegis, residency programs 
in the Navy became strong; because a significant pay 
differential between service and civilian residencies did 
exist at that time, the service programs were always 
filled. 

In 1958, CAPT DJ. O'Brien, MC, USNR, then Direc- 
tor, Reserve Division, BUMED, authored the Senior 
Medical Student Program (SMSP) as part of the Ensign 
program. His testimony and that of Admiral Hogan 
secured funding from the Congress for 200 such billets 




CAPT Donald P. O'Brien, MC, USNR 



38 



U.S. Navy Medicine 



annually. This program placed senior students on ac- 
tive duty with its attendant pay and perquisites, but 
did not pay tuition. The SMSP attracted 200 students 
a year to accept regular Navy commissions, along with 
three years of obligated service. About this same time 
the Ensign program was redesignated the Ensign 1915 
program. 

The SMSP has been an important source of regular 
Navy doctors, and statistics on the retention of SMSP 
participants have reflected superior staying power. This 
is because many of these men served their internship 
residency in the Navy, and often secured more desir- 
able assignments as a result of their longer commitment. 

In 1958 CAPT O'Brien also organized the first of 
several biennial seminars conducted for the Comman- 
dant's Representatives, where information essential to 
recruiting of medical students was passed. These meet- 
ings continued until 1967, when they were eliminated 
for budgetary reasons. An excellent seminar in 1964, 
sponsored by CAPT James A. Murphy, then Medical 
Reserve Program Officer at Great Lakes, included two 
days of lectures at Great Lakes and two days at the 
Mayo Clinic. 

Beginning in 1964, the Vietnam expansion and the 
attrition of World War II medical officers brought the 
problem of recruiting into sharper focus. Table III 
chronicles the recruiting efforts that were made, from 
that point, up to the present time. 





TABLE III 


CURRENT DOCTOR-PROCUREMENT EFFORTS 


Year 


Programs 


1965 - 


Organization of Ensigns 




Medical Ensign Companies 




Scholarships proposed 


1967 - 


(Army & Air Force Scholarships) 


1970 - 


Ensign 1965 Scholarship Program 


1971 - 


Reserve Forces Policy Board Meeting 


1972 - 


"HR-2" Ensign 1975 Scholarship Program 




Commandant's Representative (Com- Rep) 




Seminars resumed 


1973 - 


Corn-Reps redesignated Medical School 




Liaison Officers (MSLOs) 




MSLO Newsletter 




RADM John S. Cowan, MC, USN 



For many years. Com- Reps at medical schools were 
urged to utilize a low-key approach to student recruit- 
ing. In 1965, RADM John Cowan, MC, USN (then 
CAPT, now retired) at a Corn-Rep seminar at Willow 
Grove, Pa., made an impassioned appeal for better or- 
ganization of Navy ensigns at medical schools. Admiral 
Cowan had an unusually keen grasp of reserve affairs 
in general, and of recruiting in particular, having per- 
sonally visited all five medical schools in Philadelphia 
prior to his presentation. He accurately pointed out 
that without organization the student had little reason 
to feel he belonged to the Navy, a truism we might 
well remember in regard to our HR-2 Scholarship stu- 
ents of today. 

Following the Willow Grove Seminar, RADM R.B. 
Brown, MC, USN, then Surgeon General (and later 
VADM), who had attended the seminar, first autho- 
rized the organization of students into Medical Ensign 



^^n ■% xB> ^^ i^ff 9 



VADM Robert B. Brown, MC, USN 
Surgeon General 1965-1969 



Volume 63, May 1974 



39 



Companies. This particular device proved invaluable 
in recruiting, particularly in the Ninth Naval District. 
With clear vision of what would be required to recruit 
students, Admiral Brown also worked tirelessly during 
his tenure to secure scholarship subsidies. 

In 1967 the Army & Air Force offered medical schol- 
arships, but the numbers were small and the incurred 
obligation, lengthy. The scholarships were widely 
touted however, and hurt Navy recruiting efforts at 
that time because the Navy had none. 

Any discussion of medical student recruiting would 
be grossly incomplete should it fail to mention the 
signal accomplishments of CAPT Thomas J. Canty, MC, 
USN (now retired), who was Medical Reserve Program 
Officer in the Ninth Naval District, from 1965 to 1968. 
CAPT Canty was much better known to the regular 
Navy as the founder of the Orthopedic Rehabilitation 
Center at Oak Knoll, for performing over 7,000 ampu- 
tations without a fatality, and for commanding Naval 
Hospital Camp Pendelton; he brought to his last assign- 
ment all the vigor of his earlier career, and the wisdom 
of his vast experience. 

Through extensive visitation CAPT Canty got to 
know every medical school dean in the Ninth Naval 
District personally, and presented citations to those 
who cooperated with the Navy. He appointed "Assis- 
tant Com- Reps" from among the ensigns at each school, 
to assist with recruiting. He picked up the Ensign 
Company concept and established more than ten such 
companies in the Ninth Naval District. He authored a 
curriculum for training these companies. Many, many 
students who were members of such companies in the 
late 1960s are on active duty today, and it is safe to 
state that if one could tabulate the largest number of 
medical officers recruited by the efforts of any single 
individual, that honor would go to CAPT T.J. Canty, 




CAPT Thomas J. Canty, MC, USN 



who also organized an outstanding seminar at Great 
Lakes in 1966. 

While the Medical Ensign Companies were to prove 
effective organizational and recruiting devices, they 
were difficult to maintain. It was almost impossible 
to force these units into the mold which was cast for 
other post-active-duty reserve companies, and it was 
difficult to secure people to run these companies on a 
strictly voluntary, nonpay basis. Constant turnover, drill 
schedules and reports, and fitness reports were problems, 
to mention but a few. At present, HR-2 Scholarship 
students are not permitted to join reserve companies, 
so, unfortunately the demise of this useful instrument 
(the Medical Ensign Company) seems imminent. 

THE PRESENT 

In 1970 the Ensign-1965 Scholarship program first 
became available. It was (and is) a tremendous pro- 
gram for the recipient: he is placed on full-time active 
duty plus scholarship, but the number of billets is small 
{100 for all four years), and the program is costly for 
the number of doctor years secured. 

Also, in 1970, CAPT Wendell A. Johnson, MC, USN 
(now retired) became Director, Reserve Division, 
BUMED, and launched an extensive and revitalized re- 
cruiting program which continues and expands to this 
date. In 1971 he sent Navy representatives who accom- 
panied him to the Reserve Forces Policy Board in the 
Pentagon; the Board strongly recommended the pres- 
ent scholarship program. His extensive visitation pro- 
gram to medical schools has greatly rejuvenated re- 
cruiting efforts, as have the two Seminars on Medical 
Student Recruiting, sponsored by BUMED in 1972. 
The BUMED Reserve Division (Code 36) now gener- 
ates a newsletter for Navy representatives at medical 
schools, who are now designated Medical School Liaison 
Officers (MSLOs), In addition to those mentioned 
herein by name, many other people have worked dili- 
gently to recruit students. Their contribution is grate- 
fully acknowledged, and their numbers too great to 
enumerate individually. 

For all of the above, the most important recent de- 
velopment for the recruitment of medical students is 
the Armed Forces Health Professions Scholarship legis- 
lation of 1972, the HR-2 Bill, or Ensign 1975 Program. 
By this legislation the Navy was authorized to place 
1,000 medical students on scholarship with a $400.00 
per month stipend, on the condition that they would 
spend one year on active duty as a doctor for each 
year of subsidy received, with a minimum pay back of 
two years. These students are also placed on active 
duty for six weeks per year, at a naval hospital or 



40 



U.S. Navy Medicine 



research facility if possible. As generous a program 
as this is, it is surprising that almost one year was re- 
quired to fill the billets authorized by the initial legis- 
lation. In any case, ft certainly gives the MSLO some- 
thing very worthwhile to sell. So much for history. 

How does one recruit the medical student of today? 
Most of course are recruited by Naval officers on the 
faculty of medical schools. An effective recruiter must 
have certain attributes. First and foremost, he must do 
his faculty job well. If he cannot do this, he cannot 
secure the respect of the students, or the cooperation 
of his colleagues. He must also be informed, available, 
honest, concerned, and helpful. While no individual 
possesses all of these attributes in perfection, to the 
extent that he develops them, he will be able to recruit. 

The Medical School Liaison Officer (MSLO) cannot 
be effective alone. He must effect liaison with his 
Dean, his registrar, and other faculty members. Area 
recruiting-station personnel and the newly designated 
Area District Medical Recruiter are people he must 
know. He should know his district program officer, 
and personnel in BUMED who can help him. He should 
know people in neighboring service hospitals and bases, 
to which students can be taken. 

Proven recruiting devices include the following: 
sending a welcoming letter to incoming freshmen, in- 
viting them to join the Navy programs; addressing the 
newcomers on registration day; addressing medical fra- 
ternities and premed clubs, projecting Navy movies; or- 
ganizing the Navy people who are present and doing 
things with them as a group; getting the students to 
active duty; promoting esprit by downward loyalty. 
Field trips to naval hospitals are particularly rewarding 
and will be increasingly available under present recruit- 
ing funding priorities. There are of course many other 
devices which have been used successfully, depending 
to a large extent upon the dedication, leadership, and 
enthusiasm of the liaison officer. 

THE FUTURE 

What of the future? Some fundamental needs are 
projected in Table IV. 

While the present 1975 program is a great recruiter, 
it will not begin to pay off for two or more years; even 
then, it may yield an insufficient number of doctors 
annually to meet attrition. Perhaps partial scholarships, 
or scholarships without stipend could also be considered 
for a shorter payback. Those of us who try to contact 
medical students are certain of one thing; there must 
be some organization of the Navy students at each 
school. This "unit" should also be the source of some 
indoctrination for Naval officers. We have much to 



TABLE IV 
FUTURE NEEDS 
More (& different) scholarships 
Organization of ensigns at the schools 
Support and pay for the MSLO 
Medical quotas for Recruiting Districts 
Challenging career opportunities 



learn in this area from NROTC units; and the 1975 
program is, in fact, a medical ROTC. 

Until recently, Navy representatives at medical 
schools have received little support. They need secre- 
tarial help, autovon or FTS capabilities, and enough 
money to get their uniforms pressed or buy a student's 
breakfast on occasion. 

Recruiting stations should be given quotas to fill in 
the recruiting of medical students. While some of us 
enjoy great cooperation, there is evidence that some 
recruiting stations do not even know that the Ensign- 
1975 program exists. If counted on their quotas, the 
1975 Ensigns might also be processed more expedi- 
tiously for commissioning. 

In any discussion of recruiting, the related problem 
of retention must be addressed. Most young officers 
today are still leaving the service after their obligated 
duty is completed. They do so primarily for money, 
but also for ego satisfaction which many feel is lacking 
in the service. Many concerned people fee! that a pay 
increase is absolutely essential if the Armed Forces 
Medical Corps are to survive. The services are doing 
much to challenge the young physician. It is the re- 
sponsibility of every senior officer to try to do more. 
The physician that enters military service right after 
training may not fully realize that civilian practice is 
not without its frustrations, particularly the longer 
working hours which are usually involved. 

Finally, it goes without saying that every Navy doc- 
tor, every Navy person who believes in the present 
system of health care for the military must be a re- 
cruiter. There are still a "few good men" who like 
change of climate, the sea, a career which is different, 
or who possibly even regard a few years of military 
service as a reasonable price for American citizenship. 
Our job is to find these men, sell them a worthwhile 
program, and fortify their interest in a naval medical 
career.?? 



Volume 63, May 1974 



41 



NATIONAL 

VOLUNTEER 

WEEK^P 



National Volunteer Week was observed throughout 
the Nation during April 21-27, 1974. This was the 
first time that a specific week had been singled out for 
the entire Nation to say "Thank you" to the men, 
women, and young people who give countless hours of 
generous volunteer service to others. 

For the U.S. Navy Medical Department, this week 
provided a welcome opportunity to turn the spotlight 
on the dedicated, trained, and concerned individuals 
who volunteer their time and talents to serve in our 
medical facilities. 




VOLUNTEER POWER.— JANGO volunteers check a pa- 
tient's pulse and temperature at the National Naval Medical 
Center, Bethesda, Md. 




Photographs of volunteers at the National Naval Medical 
Center, Bethesda, Md., were taken by HM2 Garry Silk and 
HM2 Earl MacDonald. 



HELPING OUT.— Red Cross volunteer Jeanne Sonken brings 
a patient a poster to brighten his stay at the National Naval 
Medical Center, Bethesda, Md. 



Who are these volunteers? Where do they come 
from? What do they do? 

Well, those bright young faces that light up our 
wards and clinics belong to members of JANGO (Junior 
Army-Navy Guild Organization}. They are 14 to 18 
years old, the daughters of military personnel or direct 
Presidential appointees, and they have all completed 
25 hours of training to be junior nurses' aides. The 
girls have a special affinity for the pediatric, medical, 
and surgical wards, where they provide valuable patient 
care. Under the supervision of the chief nurse of the 
ward, the girls record temperature, pulse, and respira- 
tion; give baths; make beds; feed and transport patients; 
and run errands. They continue their training by at- 
tending monthly meetings with the registered nurse 
who supervises the JANGO program. 

Another important volunteer effort at naval medical 
facilities is the Navy Relief Program. Navy Relief is a 
private social service organization which provides assis- 
tance to Navy and Marine Corps dependents in times 
of emergency. Most of the volunteer participants are 
the wives of active duty or retired military personnel. 
These hard-working women offer social services to hos- 
pital staff members and inpatients in a wide range of 
areas. Many volunteer hours are spent knitting or cro- 
cheting baby layettes, known as "new baby sea bags," 
which are made available to new parents on the basis 
of need. New parents are also offered financial coun- 
seling on request. In many naval medical facilities. 
Navy Relief volunteers have set up free nurseries where 
mothers can leave their children while they keep a 
medical appointment. 



42 



UJS. Navy Medicine 



Navy Relief volunteers work closely with the Ameri- 
can Red Cross, an organization with its own long his- 
tory of service in military hospitals. Although no sta- 
tistics are available which document the total number 
of hours of service donated by Red Cross volunteers 
each year in naval facilities around the world, it is still 
possible to obtain some idea of the vast resource these 
volunteers represent. For example, during Fiscal Year 
1973 Red Cross volunteers at five major Naval Hos- 
pitals (Bethesda, San Diego, Long Beach, Oakland, and 
Portsmouth, Va.) gave a total of 149,211 hours of ser- 
vice. The financial savings this service represents for 
our medical facilities is inestimable, as is the positive 
effect these volunteers have on patient morale. 

Nearly fifty percent of Red Cross volunteers are 
drawn from the civilian community; the other half are 
wives and daughters of military personnel. Red Cross 
volunteers help run recreation programs for patients, 
visit the wards with library and craft carts, arrange for 
birthday parties and holiday celebrations, plan Bingo 
and card games, sponsor folk-singing programs, and 
provide other entertainment. Volunteers also offer 
patients personal services, such as shopping and writing 
letters. Under the supervision of professional case 
workers, some Red Cross volunteers provide a social 
case work service to inpatients. 

Volunteers work in naval medical facilities for the 
sheer satisfaction of providing service to others. But it's 
a rare volunteer who wants to be totally anonymous. 
Most appreciate some recognition of their efforts. Dur- 
ing National Volunteer Week the Navy Medical Depart- 
ment made special efforts to honor volunteers as People 
of the Hour. 

What would we do without them? 





A TOUCH OF BLARNEY— Red Cross volunteers at NAV- 
REGMEDCEN San Diego, Calif., help a patient celebrate St. 
Patrick's Day with his very own Blarney Stone. At the left is 
Ragean Kerns; on the right is Linda Sackson. 



NAVY RELIEF.— Mrs. Charlotte Gregg, a volunteer with 
the Navy Relief Society at the National Naval Medical Center, 
Bethesda, Md., listens as a Navy man describes his need for 
help. The Navy Relief Society provides military dependents 
with emergency financial help and other social services. 




RED CROSS VOLUNTEER. -Mrs. C. Richter (right) posi- 
tions PN3 Kathy M. Walker for a chest X-ray. Mrs. Richter 
is a Red Cross volunteer who works under professional super- 
vision at Nav Hosp Pensacola, Fla. 



Volume 63, May 1974 



43 



BE A VIP 




YOU ARE 
NEEDED 




HELPING HAND,— Lillian Baines, R.N., a Red Cross volunteer, offers P01 Richard Grosse a 
helping hand in the emergency room of Nav Hosp Pensacola, Fla. Miss Baines is a retired Navy 
nurse. 




WRITING HOME.— At Nav Hosp Pensacola, Fla., Red Cross 
volunteer Mrs. S.E. Pepek helps PN2 Stanley W. Stephens (left) 
and MM1 Edwin Watson (center) prepare Marsgrams. The mes- 
sages are transmitted to the men's families via local ham radio 
operators. 




FINE ART.— SN Lewis Nichols, an orthopedic patient at 
Nav Hosp Pensacola, Fla., is instructed in art techniques by 
Red Cross volunteer Mrs. E. Talbot. Mrs. Talbot is an experi- 
enced artist and teacher. 



44 



US. Navy Medicine 





A FUTURE JANGO?— Terry Jacoby (left), daughter of 
RADM William Jacoby, MC, USN (Chairman of the Internal 
Medicine Service at NNMC, Bethesda), and Anne Henderson 
(right) are already convincing a third potential candidate that 
JANGOs are very special people. (These winsome young ladies 
graced the front cover of our April issue.) 



IN THE CLI NIC-Mrs. J.C. Quititquit (right). Red Cross 
volunteer at Nav Hosp Pensacola, Fla., capably augments the 
staff of the ENT Clinic. Here she assists HM3 Bud McLean in 
completing an audiometric evaluation of Sharroll Bedgood (left). 




BE A VIP 




YOU ARE 
NEEDED 



JANGOS AT WORK.— Volunteer JANGOs assist a patient at the National Naval Medical Center, 
Bethesda, Md.^f 



Volume 63, May 1974 



45 




VADM J.L. HOLLOWAY, II! 
NOMINATED FOR CNO 



VADM James L. Holloway, III, USN, who com- 
manded the first nuclear-powered ship to engage in com- 
bat, has been nominated for the office of Chief of Naval 
Operations (CNO). He will succeed VADM Elmo R. 
Zumwalt, USN, who retires 29 Jun. 















A 


*m*'* c ^^^. >w, a M 








*^^N ^^^m ^^^1 
































f v F>m mi 


K^~ 




■ 


M^m\ \ \ \ ^^^^^H 

m\\ WW mM 




_ 







VADM James L. Holloway, 111, Vice Chief of Naval Opera- 
tions, Navy Department, has been nominated for the office of 
Chief of Naval Operations. 



A graduate of the US Naval Academy Class of 1943, 
ADM Holloway served on destroyers in both the 
Atlantic and Pacific theatres during WWII. As a gun- 
nery officer in the USS Bennion, he participated in the 
Leyte landings and in the capture and occupation of 
Saipan, the Southern Palau Islands, and Tinian. During 
the Leyte campaign he took part in the Battle of 
Suriago Straits, the largest naval surface action in 
history. 

Upon completing flight training after the war, ADM 
Holloway flew Curtiss Helldivers from the carrier USS 
Kearsarge. He later served in Korea as Operations 
Officer of Air Task Group ONE, flying jet fighters from 
the USS Valley Forge, and as Executive Officer of 
Fighter Squadron FIFTY-TWO in the USS Boxer. 

In 1958 ADM Holloway assumed command of Attack 
Squadron EIGHTY -THREE, an A-4 Skyhawk squadron 
deployed aboard the USS Essex with the Sixth Fleet, 
and participated in the Lebanon landings. His squadron 
later became part of the Seventh Fleet during the 
Quemoy-Matsu crisis in Oct 1958. 

After serving as Administrative Aide to the Deputy 
Chief of Naval Operations for Air, and as CO of the 
USS Salisbury Sound, ADM Holloway was selected to 
train under VADM Hyman G. Rickover, USN (Ret.), 
in the Naval Reactors Division of the Atomic Energy Di- 
vision. He assumed command of the USS Enterprise, the 
Navy's only nuclear-powered carrier in Jul 1965, and 
five months later saw action in the South China Sea. 
This was the first time that a nuclear-powered ship had 
engaged in combat. ADM Holloway served two full 
combat tours in Enterprise, during which time the ship 



46 



US. Navy Medicine 



was awarded the Navy Unit Commendation and won 
the coveted "E" for standing first in battle efficiency 
among attack carriers in the Pacific Fleet. At 44 years 
of age, ADM Holloway was among the youngest navai 
officers in modern times to be selected for promotion 
to RADM in May 1966. 

In 1967 ADM Holloway returned to Washington to 
the Office of the Deputy Chief of Naval Operations for 
Plans and Policy. He served on the Panel to Review 
Safety in Carrier Operations, and conducted a special 
study on the costs of new ship construction. He then 
established the Nuclear Attack Carrier Program as 
Program Coordinator; he also served as Director of 
the Strike Warfare Division in the Office of the 
CNO. 

ADM Holloway became Commander of Carrier Divi- 
sion SIX in 1970. Later that year, while embarked in 
the aircraft carrier USS Saratoga, he directed operations 
in the eastern Mediterranean during the Jordanian crisis. 
ADM Holloway subsequently served as Deputy Com- 
mander in Chief Atlantic and U.S. Atlantic Fleet. Pro- 
moted to the rank of VADM in Feb 1971, he assumed 
command of the Seventh Fleet in May 1972. He was 
designated Vice Chief of Naval Operations in May 1973, 
in which position he was serving at the time of his 
recent nomination. 

ADM Holloway's decorations include three awards 
of the Distinguished Service Medal, two awards of the 
Legion of Merit, the Distinguished Flying Cross, the 
Bronze Star Medal with Combat "V," the Air Medal 
with two Gold Stars, the Navy Commendation Medal 
with Gold Star and Combat "V," the National Order 
of Vietnam Fifth Class, and the Republic of Vietnam 
Gallantry Cross with Palm. He also holds many cam- 
paign and service medals,?? 



NORFOLK NAV REG DENTAL CENTER 
CONTINUING EDUCATION PROGRAMS 

Naval Regional Dental Center, Norfolk, Va., recently 
received approval of the Academy of General Dentistry 
for continuing education programs. The continuing 
education programs are acceptable for fellowship and 
membership-maintenance credit. Programs conducted 
to date include a one-hour weekly officers' conference, 
periodic three-hour evening seminars in the dental spe- 
cialties moderated by Board-qualified/certified staff per- 
sonnel, and quarterly tri-service dinner meetings with 
Army and Air Force dental officers. In addition, cas- 
ualty care and officer indoctrination courses are con- 
ducted by the Dental Center several times each year. — 
BUM ED, Code 6.t? 



NEW ASSIGNMENT POLICY 
FOR HC SCHOOL GRADUATES 

Hospital corpsmen graduating from Class A basic 
Hospital Corps schools may now be assigned to any 
billet requiring their rate, including billets with the op- 
erating forces or the Fleet Marine Force. This change 
in policy is necessitated by the rapid turnover in per- 
sonnel in the lower pay grades, and is designed to offer 
Hospital Corps personnel a stable first-duty assignment 
after completion of initial training. — BUM ED, Code 
34.? 



ACDUTRA OPPORTUNITIES 
FOR NAVAL RESERVISTS 

There will be an unusually large number of active 
duty for training (ACDUTRA) opportunities available 
to Naval Reservists during the coming summer months. 

Any Medical Department Reservist who would like a 
meaningful tour of ACDUTRA can find it in the fol- 
lowing list of billets. All opportunities will be available 
during the period 23 Jun through 20 Jul, and all are 
designated for naval hospitals or regional medical centers 
unless otherwise indicated. Interested, eligible Reservists 
should make applications for ACDUTRA using the ap- 
propriate chain of command. 

Billets marked with an asterisk (*) are those in which 
the requirement for assistance is critical. — BUMED, 
Code 36A. 

ANESTHESIOLOGY 

*Patuxent River, Md. 
Whidbey Island, Wash. 
*NRMC, Portsmouth, Va. 

DERMATOLOGY 

*NRMC, Portsmouth, Va. 

Annapolis, Md. 
Corpus Christi, Tex. 
Great Lakes, III. 



(6/15 thru 7/31) 



(6/15 thru 7/31) 



ENT 

*NRMC, Portsmouth, Va. (6/15 thru 7/31) 

FLIGHT SURGERY 

*NRMC, Jacksonville, Fla. (6/1 thru 7/31) 
*NRMC, Portsmouth, Va. (6/15 thru 8/30) 



Volume 63, May 1974 



47 



GENERAL MEDICAL OFFICERS (all billets available 
7/1 thru 7/21} 

"NAVWEAPLAB, Dahlgren, Va. 
"NAVORDSTA, Indian Head, Md. 
*NAS, Brunswick, Maine 
*NAVSTA, Newport, R.I. 
*NAVACT, Brooklyn, N.Y. 
*NPTU, Schenectady, N.Y. 
*NAS, Lakehurst, N.J. 
"NTC, Bainbridge, Md. 
*NAVBASE, Norfolk, Va. 
"Boone Clinic, NAVPHIBASE, Norfolk, Va. 
"NAS, Oceana, Va. (Va. Beach, Va.) 
"NRMC, Beaufort, S.C. 
"NAS, Glynco, Ga. 
*NAS, Atlanta, Ga. 

*NAVSTA, Mayport, Fla. (Jacksonville) 
*NAS, Memphis, Tenn. 
*CTC, Pensacola, Fla. 
*NAS, Meridian, Miss. 
"CBCENTER, Gulfport, Miss. 
*NAS, Kingsville, Tex. 
*NAS, Dallas, Tex. 
"NTC, Great Lakes, III. 
*NAF, Detroit, Mich. 
*NAS, Miramar (San Diego), Calif. 
"MCRD, San Diego, Calif. 
"NAVSTA, San Diego, Calif. 
"NTC, San Diego, Calif. 
*MCB, 29 Palms, Calif. 
*MCAS, Yuma, Ariz. 
"MCSC, Barstow, Calif. 
*NAS, Alameda (Oakland), Calif. 
"NAVDISP, Seattle, Wash. 
"NAU, Idaho Falls, Idaho 

"NAVSTA, Adak, Alaska (available to reservists re- 
siding west of the Mississippi) 

GENERAL SURGERY 

"Portsmouth, N.H. (6/15 thru -7/15) 

Charleston, S.C. 
*Whidbey Island, Wash. 
*NRMC, Portsmouth, Va. (6/15 thru 7/31) 
"Memphis, Tenn. (5/1 thru 7/31) 

INTERNAL MEDICINE 

"Annapolis, Md. (two per two-week period, 6/15 

thru 8/15) 
"Cherry Point, N.C. 

"NRMC, Portsmouth, Va. (6/1 thru 7/31) 
"Patuxent River, Md. (6/1 thru 7/31) 
"MCAS, El Toro, Calif. (6/24 thru 7/30) 



NEUROLOGY 

Camp Lejeune, N.C. (Clinical) 
Camp Pendleton, Calif. 
Great Lakes, III. 
Long Beach, Calif. 

OB-GYN 

"Annapolis, Md. (6/15 thru 8/15) 
"Patuxent River, Md. (7/15 thru 7/26) 
"NRMC, Portsmouth, Va. (6/15 thru 7/31) 

OPHTHALMOLOGY 

"Jacksonville, Fla. (6/1 thru 8/30) 
"NRMC, Portsmouth, Va. (6/15 thru 7/31) 

ORTHOPEDICS 

"Patuxent River, Md. (6/1 thru 7/31) 

PATHOLOGY 

"Jacksonville, Fla. 

"Memphis, Tenn. 

"Newport, R.I. 

"NRMC, Portsmouth, Va. (6/15 thru 7/31) 

PSYCHIATRY 



(6/15 thru 7/31) 



Camp Lejeune, N.C. 
NRMC, Portsmouth, Va. 
Jacksonville, Fla. 
Bremerton, Wash. 
Charleston, S.C. 
Key West, Fla. 
Memphis, Tenn. 
Newport, R.I. 

PEDIATRICS 

"NRMC, Portsmouth, Va. (6/15 thru 7/31) 

Bremerton, Wash. 
"Lemoore, Calif. 

Orlando, Fla. 
"Port Hueneme, Calif. 
"Quantico, Va. 
"Patuxent River, Md. (6/1 thru 7/31) 

MCAS, El Toro, Calif. (6/24 thru 7/30) 

PLASTIC SURGERY 
Philadelphia, Pa. 



48 



U.S. Navy Medicine 



RADIOLOGY 

*Bremerton, Wash. 
*Lemoore, Calif. 
*Patuxent River, Md. 
*Whidbey Island, Wash. 
*New London, Conn, 
NRMC, Portsmouth, Va. (6/15 thru 7/31) 

UROLOGY 

*Pensacola, Fla. 
Charleston, S.C. 
Jacksonville, Fla. (6/1 thru 8/30) 

ANESTHESIOLOGY 

*NH, Roosevelt Roads, P.R. 

GENERAL SURGERY 

*NAVTRACOM, Kenitra, Morocco (6/16 thru 6/29) 
*NH, Guantanamo Bay, Cuba {6/12 thru 7/20) 
*NH, Roosevelt Roads, P.R. 

INTERNAL MEDICINE 

*NH, Guantanamo Bay, Cuba (6/12 thru 7/20) 
PEDIATRICS 

*NH, Guantanamo Bay, Cuba (6/12 thru 7/20) 
ORTHOPEDIC SURGERY 

*NH, Guantanamo Bay, Cuba (6/12 thru 7/20) 
RADIOLOGY 

*NH, Guantanamo Bay, Cuba 

ACDUTRA opportunities for Medical Service Corps 
officers are as follows: 

NRMC, Memphis, Tenn.. . . "Optometrists 

(Continuing requirement) 

NNMC, Bethesda, Md 'Pharmacist 

(5/20 thru 6/3} 

There will be a continuing requirement at all hospitals 
for corpsmen in the five technical areas listed below. 
The number of opportunities will vary with the activity 



concerned. Inquiries regarding ACDUTRA should be 
directed to the command at which the individual Re- 
servist desires duty. The requirement at Quantico is 
for the support of the summer Platoon Leader Course. 



All hospitals: 



MCE DC, Quantico, Va: 



Operating room technicians 
Laboratory technicians 
X-ray technicians 
Pharmacy technicians 
Neuropsychiatric technicians. 

All technic specialties and 
general service (Require 20 
hospital corpsmen each two- 
week period, 7/1 thru 8/31).^ 



BILLETS AVAILABLE FOR SECOND-TOUR 
FLIGHT SURGEONS 

In accordance with Bureau of Naval Personnel pol- 
icy, the projected rotation date (PRD) has taken on 
increased importance. Present policy prohibits the 
transfer of any officer prior to his PRD. The initial 
operational tour for most flight surgeons is two years 
unless they are in a billet with specific tour require- 
ments, e.g., Hawaii, Adak, Naples, First Marine Air 
Wing. Any flight surgeon approaching his PRD may 
request a permanent change of duty if he agrees to 
remain at his new duty station for a minimum of 
one year in the continental United States, or for the 
BUPERS-required tour at overseas bases. The majority 
of flight surgeons in receipt of release from active duty 
orders are eligible for transfer to a duty station of their 
choice if they desire to extend. 

The following list of billets are available to any 
second-tour flight surgeon, dependent on prior commit- 
ment; in other words, first come first served. All inter- 
ested flight surgeons may contact CAPT H.S. Trostle, 
MC, USN, (Code 51, BUM ED), or call Autovon 294- 
4183 for additional information. 

FLIGHT SURGEON BILLETS AVAILABLE: 

NAS, AGANA, GUAM 
Assistant SMO 
VQ-3 

NAS, ALAMEDA, CALIF. 
Assistant SMO 
NARU 
VAQ-130 



Volume 63, May .1974 



49 



ANTARCTIC SUPPORT ACTIVITY 

NAS, ATLANTA, GA. 

BARBERS POINT, HAWAII 
Assistant SMO 
VP Squadron 

MCAS, BEAUFORT, S.C. 
Marine Air Group 

NAS, BRUNSWICK, MAINE 
Assistant SMO 
VP Squadron 

NAS, CECIL FIELD, FLA. 
VA-45 

Attack Carrier Air Wing 
Light Attack Wing One 

NAS, CHASE FIELD, FLA. 

MCAS, CHERRY POINT, N.C. 
Hospital Flight Surgeon 
Second Marine Air Wing 

NAF, CHINA LAKE, CALIF. 

NAS, CORPUS CHRIST), TEX. 

NAS, CUBI POINT, REPUBLIC OF PHILIPPINES 

NAS, DALLAS, TEX. 

NAF. DETROIT, MICH. 

NATIONAL PARACHUTE FACILITY, EL CENTRO, CALIF. 

MCAS, EL TORO, CALIF. 
Assistant SMO 
Third Marine Air Wing 

NAS, FALLON, NEV. 

NAS, GLENVIEW, ILL. 

NAS, GUANTANAMO BAY, CUBA 

NAS, JACKSONVILLE, FLA. 
Assistant SMO 
VP Squadron 
HS Wing One 

NAVAIRDEVCEN, WARMINSTER, PA. 



MCAS, KANEOHE, HAWAII 
First Marine Brigade 

PACIFIC MISSILE RANGE, KAUA!, HAWAII 

NAS, KEY WEST, FLA. 
Assistant SMO 
VF-101 

NAS, LAKEHURST, N.J. 
Assistant SMO 
NARU 

LEMOORE, CALIF. 
Attack Carrier Air Wing 

NAS, MEMPHIS, TENN. 
Assistant SMO 

NAS, MERIDIAN, MISS. 
TRAWING ONE 

NAS, MIRAMAR, CALIF. 
Attack Carrier Air Wing 

NAS, MOFFETT FIELD, 'CALIF. 
Assistant SMO 
VP Squadron 

NAVAL POSTGRADUATE SCHOOL, MONTEREY, CALIF. 

NAPLES, ITALY 

COMFAIRMED 
VR-24 

NAS, NEW ORLEANS, LA. 

NAVSTA, NEWPORT, R.I. 

MCAS, NEW RIVER (Jacksonville), N.C. 
SMO 
MAG-26, 29 — Helicopter Squadrons 

NAS, NORFOLK, VA. 
Assistant SMO 
Naval Safety Center 
CAEWW-12 
VR-1 
HM-12 

NAS, OCEANA, VA. 
Attack Carrier Air Wing 



50 



US. Navy Medicine 



PATUXENT RIVER, MD. 
Naval Hospital 
Naval Air Test Center 
VQ-4 
VP-30 
VX-1 

PENSACOLA, FLA. 
NAMI 



Abstracts of proposed papers should be submitted 
by 1 Jun 1974 to appropriate national representatives, 
or one of the following officials: 

COL I.A. Marriott, MC, CF 
Program Chairman 
Director of Preventive Medicine 
National Defense Headquarters 
Ottawa, Ontario, Canada K1A-OK2 



NAS, POINT MUGU. CALIF. 

Assistant SMO 
NARU 

MCAS, QUANTICO, VA. 

Assistant SMO 



MAJ Robert R. McMeekin, MC, USA 

Secretary, Joint Committee on Aviation Pathology 

Chief Aerospace Branch 

Armed Forces Institute of Pathology 

Room M-127 

Washington, D.C. 20306.^ 



ROOSEVELT ROADS, P.R. 
Naval Hospital 

NAS, NORTH ISLAND, CALIF. 
Assistant SMO 
NARU 
CAEWW-1 1 

NAS, SOUTH WEYMOUTH, MASS. 

WHIDBEY ISLAND, WASH. 
Assistant SMO 
COMFAIRWHIDBEY 

NAS, WHITING FIELD, FLA. 

NAS, WILLOW GROVE, PA. 
Assistant SMO 

MCAS, YUMA, ARIZ. ^ 



CALL FOR PAPERS: JOINT COMMITTEE ON 
AVIATION PATHOLOGY 

The Ninth Biennial Scientific Session of the Defense 
and Civil Institute of Environmental Medicine will be 
held 17-19 Sep 1974 in Toronto, Ontario, Canada. 
Papers are invited on the following subjects: cardio- 
vascular pathology, methodology in aircraft accident 
investigations, alcohol and nonmedical drugs in aviation, 
fatigue and human reliability-postaccident analysis, com- 
puter applications in accident analysis, and air-traffic 
control as a human factor in aircraft accidents. 



PROFESSIONAL EDUCATION AVAILABLE 
THROUGH NAVY-SPONSORED PROGRAMS 

Navy Medical Department personnel can take advan- 
tage of many Navy-sponsored opportunities for profes- 
sional education. Boards meet throughout the year to 
pick candidates for special programs. General eligibility 
criteria for the various programs and approximate con- 
vening dates of the selecting boards are given below. 
For more information, contact your local education 
and training officer, or write the training representative 
for your Corps. 

Navy Enlisted Nurse Education Program (NENEP) — 
Offers E-4s and above, in Hospital Corps and dental 
technician ratings, the opportunity to pursue nursing 
education leading to a baccalaureate degree and com- 
mission as Nurse Corps ensigns. Students selected for 
this program receive pay and allowances of their rate, 
as well as tuition, fees, and textbooks. Both men and 
women may apply. Applications are due in the Navy 
Recruiting Command each year by 1 Jan. Board meets 
in February or March. 

Navy Enlisted Dietetics Education Program (NEDEP) 
— Offers enlisted men and women two- or three-year 
college educations leading to a bachelor's degree in med- 
ical dietetics, and to commission as an ensign in the 
Medical Service Corps. Students in this program receive 
the pay and allowances of their rate, as well as payment 
of tuition, fees, and textbooks. Upon completion of 
their academic programs, students are commissioned in 
the Medical Service Corps and are obligated to serve 
four years' active duty. Applications are due each year 
by 1 Jan. Board meets in late January. 

Medical Service Corps (MSC) Student Program — 
This established program was developed to provide 



Volume 63, May 1974 



51 



essential input for the specialties of dietetics, physical 
therapy, occupational therapy, and health care admin- 
istration. It is an early commissioning program where- 
by students are commissioned as ensigns, and receive 
pay and allowances for that grade during their final 
year of a baccalaureate program or final two years of 
a graduate program. Students are obligated to serve 
three years' active duty upon completion of their aca- 
demic program. 

Dental Scholarship Program — Open to all active-duty 
Navy and Marine Corps officers, enlisted personnel, and 
inactive-duty Reservists who have been accepted or are 
enrolled in dental schools approved by the American 
Dental Association. In addition to full tuition, fees, 
instruments, and supplies, candidates selected for this 
program will receive the pay and allowances of a naval 
officer. Students are appointed ensigns in the Naval 
Reserve and are on active duty during training. Twenty- 
four months later they are promoted to lieutenant, 
junior grade, and upon graduation from dental school 
are promoted to lieutenant. Applications are due on 
1 Apr. Board meets in May. 

Medical '/Osteopathic Scholarship Program — Open 
to all active-duty Navy and Marine Corps officers and 
enlisted personnel who are enrolled in or have been 
accepted by approved medical or osteopathic schools. 
The Navy pays full tuition and $200 a year for books. 
Students get officer pay depending on their rank. Pro- 
gram participants are first appointed as ensigns. Twenty- 
four months later they are promoted to the rank of 
lieutenant junior grade, and upon graduation from med- 
ical or osteopathic school they are promoted to the 
rank of lieutenant. Applications are due 15 Apr. 
Board meets in April. 

Armed Forces Health Professional Scholarship Pro- 
gram — Applicants must be U.S. citizens, eligible for 
Reserve commissions, who are enrolled in or accepted 
by approved medical, osteopathic, or dental schools. 
In addition, the Navy sponsors optometry students for 
the final two years of their academic program, and 
clinical psychology students at the Ph.D. level. Se- 
lectees receive $400 a month in addition to tuition, 
books, laboratory expenses and fees; they are eligible 
for commission as Reserve ensigns. Each graduate must 
serve on active duty one year for each year of schooling 
received. Minimum obligation is two years. Applications 
are due 1 May for the medical program and 15 Mar for 
the dental program. 

Physician's Assistant Warrant Officer Program — Open 
to male and female hospital corpsmen in the grades of 
E-5 and above. Selectees receive one year of didactic 
training at the Air Force School of Health Care Sciences, 
Sheppard AFB, Tex. This training is followed by one 



year of clinical apprenticeship at a naval hospital. Those 
who qualify are appointed warrant officers on comple- 
tion of the two-year program. Applications are due 
1 Mar. Board meets in March. 

MEDICAL SERVICE CORPS INSERVICE 
EDUCA TION PROGRAMS 

Naval Postgraduate School — Medical Service Corps 
officers are eligible for the Navy management curricu- 
lum and are awarded a master of science degree upon 
successful completion. Students major in either person- 
nel management or financial management. Approxi- 
mately five Medical Service Corps officers attend each 
year. 

Naval School of Health Care Administration — Pro- 
vides education in the management aspects of health- 
care facilities. The program is designed primarily for 
health care administration officers selected through the 
Inservice Procurement Program. Academic credits are 
granted by The George Washington University, Wash- 
ington, D.C., and successful completion of the program 
satisfies both major and minor requirements for a 
bachelor of science degree in health care administration. 
Officers with sufficient prior college work are awarded 
a degree upon graduation. Thirty-nine officers attend 
the program each year. 

Amphibious Warfare School — One health care admin- 
istration officer attends this program each year, and 
upon completion is assigned duties with Marine Corps 
units and staffs. 

Command and Staff Course — One health care admin- 
istration officer attends this course each year. Upon 
completion, the officer is assigned to an appropriate 
Marine Corps billet. 

Armed Forces Staff College — This school represents 
the primary vehicle for assignments to fleet support 
staffs and other positions of responsibility. One health 
care administration officer attends each year. 

NURSE CORPS INSERVICE 
EDUCATION PROGRAMS 

Full-Time Undergraduate, Graduate, and Doctoral 
Instruction — Full-time instruction at civilian colleges 
and universities in nursing service administration, 
nursing education, nursing research, supervision, clinical 
specialties, and nurse practitioner programs is offered 
to qualified Nurse Corps officers of the regular Navy. 

Naval Postgraduate School — Offers Navy nurses a 
course in Navy management leading to a master of 
science degree. 

Anesthesia Program — This two-year, Navy-sponsored 
anesthesia program was established to meet the de- 
mand for, and replenish the supply of registered-nurse 



52 



U.S. Navy Medicine 



anesthetists in the Navy. This program is accredited 
by the American Association of Nurse Anesthetists 
(AANA), and consists of one year of didactic study at 
The George Washington University, Washington, D.C., 
and one year of clinical training at selected naval hos- 
pitals. Upon successful completion of the program, 
applicants are eligible to take the certification exam- 
ination of the AANA. This program is available to 
regular or Reserve Nurse Corps officers on active duty. 

Ob/Gyn Nurse Clinician Program — This eight-month 
course at a naval hospital prepares nurses in obstetrics 
and gynecology, to function in an expanded role as a 
member of the Navy health-care team. The course is 
available to regular and Reserve Navy nurses who have 
the necessary basic educational preparation, and are 
willing to obligate themselves for an additional year of 
service upon completion of training. 

Pediatric Nurse Practitioner Program — Full-time in- 
struction in civilian universities is being offered Navy 
nurses to prepare them to function as pediatric nurse 
practitioners. Courses of four- to eight-months' dura- 
tion, leading to certification, are offered to regular and 
Reserve officers; civilian training in master's degree pro- 
grams is offered to nurses of the regular Navy. 

In addition to the programs described above, the vari- 
ous corps of the Navy Medical Department offer a wide 
variety of continuing and advanced education programs. 
Medical Department personnel are encouraged to inves- 
tigate these opportunities for professional growth.^ 



FLIGHT SURGEON CURRICULUM FOR FAMILY 
PRACTICE RESIDENCY AMA-APPROVED 

The American Medical Association's Residency Re- 
view Committee for Family Practice approved in Janu- 
ary the inclusion of the Navy's flight surgeon curricu- 
lum as an elective for the last four months of the 
Family Practice Residency Program at Nav Hosp Pensa- 
cola, Fla. The Committee represents the Academy of 
Family Physicians, the American Board of Family Prac- 
tice, and the Council on Medical Education. 

To attend classes, residents enrolling in the flight sur- 
geon curriculum need only walk across a parking lot, 
from the Family Practice Clinic to the Naval Aerospace 
Medical Institute. Both are components of the Naval 
Aerospace and Regional Medical Center at Pensacola. 

The Institute's syllabus is designed to train selected 
medical officers in the specialty of aerospace medicine, 
qualifying them for the designation of Naval flight sur- 
geon upon their completion of subsequent flight in- 
doctrination. The flight surgeon student's instruction. 



which includes survival and flight training, takes six 
months to complete; however, family practice residents 
will be given professional credit only for the four 
months of academic courses. 

The 413 academic hours include 44 in ophthalmology, 
plus 24 in the Ophthalmology Clinic; 42 in cardiology; 
36 in neuropsychiatry, plus 24 In the Neuropsychiatry 
Clinic; 34 in life-support sciences (LSS), plus 30 in the 
LSS laboratory; 22 in otorhinolaryngology, plus 12 in 
the Otorhinolaryngology Clinic; and smaller numbers of 
hours in such areas as aircraft accident investigation, 
aviation dentistry, aviation pathology, aviation physical 
examination clinic, aviation safety and crash investiga- 
tion, dermatology, medical aspects of nuclear biologi- 
cal-chemical-warfare defense, operational field trips, 
operational medicine, operational medicine clinic, psy- 
chology, research orientation, shipboard orientation 
cruise, special board of flight surgeons, special guest 
lectures, and surgery. 

Pensacola's Family Practice Residency Program is un- 
der the direction of LCDR Timothy F. Harrington, MC, 
USNR. When asked if he were pleased with the AM A 
approval. Dr. Harrington said, "We are very pleased. 
This is one of the things we have been working for." 

CAPT Robert C. McDonough, MC, USN, commanding 
officer of the Naval Aerospace Medical Institute, also 
expressed pleasure on learning of the approval. "This 
will give us another source of candidates for flight sur- 
geon training," he said. "Hopefully the family practice 
specialists at hospitals at the larger air stations will be 
able to handle some of the flight surgeon workload. 
We are very pleased with the AM A approval." 

Nav Hosp Pensacola began family practice residency 
training in Jul 1972 with the opening of the Family 
Practice Clinic. There are now ten residents in training. 
LT P. Soballe, MC, USN, the first resident to enter the 
third year, has assumed the duties of chief resident. 

Quality of care is emphasized in the residency pro- 
gram. A daily chart audit is conducted, not only to 
examine the performance of the residents but also the 
performance of the staff, as all charts are reviewed 
without discrimination. These daily sessions are excel- 
lent teaching devices because they are patient oriented 
and problem oriented. The overall objective of all 
teaching is to develop competent physicians who are 
patient-oriented problem solvers, confident in their abil- 
ities and aware of their limitations. 

The patient load of the Family Practice Clinic is de- 
rived from the large retired population around Pensa- 
cola, as well as from active-duty personnel and their 
dependents. Services available include all of those 
normally provided by a family physician, including 
medicine, pediatrics, obstetrics, gynecology, surgery. 



Volume 63, May 1974 



53 



psychiatry, and preventive medicine. Residents are en- 
couraged to obtain as much information about each 
family as possible, to better understand the dynamics 
of the family in health and in illness. 

The Clinic provides private offices for the five staff 
physicians, and has eight adjacent fully equipped exam- 
ination rooms, creating four suites of offices. The team 
members share the examination rooms. With this physi- 
cal layout, the resident's resource personnel are situated 
only a few steps away for purposes of consultation. 

The facility also has a large intake area, outside the 
main-traffic pattern, where vital signs can be obtained. 
There are facilities for minor surgery, sigmoidoscopy, 
casting, and ENT examinations. There is also a small 
laboratory area where urinalysis, cultures, and other 
simple tests can be conducted without sending the 
patient to the main hospital. 

Other staff members include three licensed practical 
nurses and one hospital corpsman, all of whom function 
under the direction of the head nurse, Mrs. E. Westling, 
R.N. The clinic staff is further augmented by Red 
Cross volunteers, one file clerk, and one stenographer. 

The Clinic is designed to operate as a free-standing 
unit, in much the same manner as a private physician 
engaged in group practice might operate. Patients have 
their own physician who cares for them and the other 
members of their families. This is a new concept in 
military medicine, and one that has been very well 
received by the patients. The Clinic staff attempts to 
personalize care as much as possible, reducing waiting 
time and other problems to a minimum. Patients are 





DISTINGUISHED VISITOR.— VADM Donald L. Custis, 
MC, USN (left), the Navy Surgeon General, visited Nav Hosp 
Pensacola in Sep 1973 to celebrate the first anniversary of the 
Family Practice Residency Program. He was briefed on the 
program's progress by CDR {now CAPT) George C. Bingham, 
MC, USN (center), chairman of the Family Medicine Depart- 
ment, and; LCDR Timothy Harrington, MC, USNR (right), 
director of the residency program. 



FAMILY PRACTICE.— LCDR Timothy F. Harrington, MC, 
USNR, director of the Family Practice Residency Program at 
Nav Hosp Pensacola, Fla., stops in the waiting area to discuss 
a patient's record with Mrs. Elaine Westling. R.N. 



seen by appointment in most instances, although the 
schedule permits openings for urgent cases. 

The proximity of the Naval Aerospace Medical Insti- 
tute further enhances the program, offering the unique 
capability of testing patients with some of the most 
sophisticated and intricate equipment available to med- 
ical science. Readily available, well-trained specialists 
on staff at the Institute complement a fine staff of in- 
hospital consultants. Consulting civilian medical spe- 
cialists from the Pensacola Educational Program round 
out the complex. 

The residency program can also make use of an 
automated history and physical examination capability 
conducted by specially trained paramedical personnel. 
This capability, under the direction of LCDR A. Kaplan, 
MC, USNR, helps to establish a uniform data base for 
new families as part of the routine intake procedure. 

Night call for residents is designed to orient them to 
management problems which hospitalized patients pre- 
sent, and to familiarize residents with initial workup 
and management of patients who are admitted to the 
hospital on an emergency basis. Residents work from 
the Emergency Medical Service area during their watch, 
seeing emergencies as they arrive. 

Family practice represents a departure from the 
traditional fragmentary care rendered at many military 
facilities; personalized comprehensive care is stressed. 
With the trend toward conversion of many outpatient 
facilities to the family-practice format, it is hoped that 
increasing numbers of physicians will find this medical 
specialty professionally rewarding and personally sat- 
isfying. Patients and physicians have long yearned, 
equally, for the ideal medical situation in which they 
are allowed to interact with one another, in an attitude 
of mutual trust and respect. This may well be it — 
that long awaited concept come true.^f 



54 



V)S. Navy Medicine 



FORMER OCEANOGRAPHER NOW MD 
AT NAVREGMEDCEN SAN DIEGO 

LT Ned W. Garrigues, MC, USN, the first graduate 
to complete all four years of medical school under the 
Navy Medical Scholarship Program, is now a member 
of the staff at Naval Regional Medical Center San Diego, 
Calif. 

Dr. Garrigues became interested in medicine while 
he was a midshipman at the Naval Academy, and took 
several premed courses as part of his undergraduate 
training. He graduated from the Academy in 1968 with 
a B.S. degree in oceanography, and subsequently served 
two years as a line officer on a destroyer in the western 
Pacific. While serving in the fleet, he decided to apply 
for medical school and was accepted. 

During the same year that Dr. Garrigues entered medi- 
cal school, the Navy expanded its Medical Scholarship 
Program to include freshmen medical students. Dr. 
Garrigues was accepted into the program and attended 
the University of Kansas Medical School with full pay 
and allowances, as well as tuition and a stipend for 
books. 

At the end of his first year in medical school, Dr. 
Garrigues came to NAVREGMEDCEN San Diego for 
a clinical clerkship in the Anesthesiology and Pathology 
Departments. Two years later, after completing his 
junior year, he attended the University of Western 
Australia in Perth where he trained in orthopedic sur- 
gery. He also spent two months with the Royal Flying 




FIRST NAVAL MEDICAL-SCHOLARSHIP GRADUATE.- 
LT Ned W. Garrigues, MC, USN is the first graduate to com- 
plete all four years of medical school under the current Navy 
Medical Scholarship Program. He is a member of the staff at 
NAVREGMEDCEN San Diego, Calif. 



Doctor Service, which provides medical care to sparsely 
populated western Australia. 

Dr. Garrigues plans to begin a surgical internship in 
July, and hopes to be accepted for residency in a sur- 
gical subspecialty.^ 



DR. EILERS ADDRESSES NMTI GRADUATES 

Seventeen medical laboratory technicians and five 
medical technologists graduated from the Naval Medical 
Training institute (NMTI) on 15 Mar 1974. Guest 
speaker at the graduation was Dr. Russell J. Eilers, Spe- 
cial Consultant to the Vice-Chancellor for Health Affairs 
of the University of Kansas Medical Center, Kansas City. 

Internationally known for his work in the field of 
standardization and quality control. Dr. Eilers was the 
founding President of the National Committee for Clin- 
ical Laboratory Standards. He was the first physician 
elected to the Board of Directors of the American 
Society for Testing and Material. 

Dr. Eilers is presently Secretariat for the Americas 
of the International Commission for Standardization 
in Hematology. He is also Chairman, Council on Labo- 
ratory Improvement of the College of American Pathol- 
ogists (CAP), and received the Pathologist-of-the-Year 
Award from the American Society of Clinical Pathol- 
ogists (ASCPJ/CAP in 1972. 

During World War II, Dr. Eilers served as a Navy 
operating-room technician. He left the Navy in 1946 
as a first class petty officer. 

In his address to the graduates. Dr. Eilers stressed 
the many challenges which await them in their careers 
in laboratory medicine. He reminded the graduates 
that they must become involved with the issues that 
confront their profession today. These issues include 
the requirement for continuing- education, decisions 
regarding involvement with the unionization movement, 
relationships with pathologists and hospital administra- 
tors, and the maintenance and improvement of the 
quality of patient care. 

The 17 medical laboratory technicians graduated 
from a program affiliated with The George Washington 
University in Washington, D.C. This program gives the 
student the opportunity to earn as many as 49 semester 
hours of credit toward an Associate of Science degree 
in medical laboratory technique. 

The five technologists graduated from the AMA- 
approved School of Medical Technology conducted by 
the NMTI. CAPT M.J. Valaske, MC, USN is Director 
of the School, and Chairman of the Department of Lab- 
oratory Medicine at NNMC, Bethesda.— PAO, National 
Naval Medical Center, Bethesda, Md.$ 



Volume 63, May 1974 



55 



+ $n ^emortatn 4* 



C/4P7 James A. Addison, MC, USN (Ret), died on 
22 Mar in Washington, D.C. Born on 16 Jan 1916 in 
Shreveport, La., Dr. Addison received his BS degree 
from Centenary College in Shreveport, and his MD de- 
gree in 1942 from Louisiana State University Medical 
School in New Orleans. On 1 Aug 1942 he was com- 
missioned an ENS, HVP (hospital voluntary, proba- 
tionary). 

After completing his internship. Dr. Addison was pro- 
moted to LT; from 1943 to 1945 he served as a battal- 
ion surgeon with the 2nd Marine Division, FMF, Pacific, 
at Tarawa, Tinian, and Saipan. From 1945 to 1946, 
he was a member of the staff at Nav Hosps Portsmouth, 
Va., and Parris Island, S.C. He completed the SONA 
(Student Officer Naval Administration) course at Stan- 
ford University, Calif., in 1946, and later that year at- 
tended the School of Tropical Medicine in Guam. Dr. 
Addison then served as senior medical officer in the 
civil administration unit, Palau Islands (1946-1948), 
and completed a residency in general practice at Nav 
Hosp Boston, Chelsea, Mass. (1948-1950). 

Newly promoted to CDR, Dr. Addison became senior 
medical officer of Surgical Team 8, COMNAVFE, in 
1950. During the Korean conflict in 1951, he became 
Commanding Officer of A Medical Company, 1st Marine 
Division, FMF, Pacific. Dr. Addison subsequently served 
as: senior medical officer, USN Dispensary, Sasebo, 
Japan (1951); ward medical officer, Nav Hosp Corpus 
Christi, Tex., (1951-1953); and training officer, Field 
Medical Service Schbol, Camp Lejeune, N.C., (1953- 
1954). After one year of study at Senior School, 
Quantico, Va., Dr. Addison became CO of the 1st Med- 
ical Battalion, 1st Marine Division, Camp Pendleton, 
Calif., (1955-1956). From 1956 to 1957, he served as 
division surgeon, 3rd Marine Division, Okinawa. Dr. 
Addison was promoted to the rank of CAPT in 1956. 
He subsequently served in the Planning Division of the 
Bureau of Medicine and Surgery, until his retirement 
on 1 Sep 1971. 

In addition to the Presidential Unit Citation with 
four stars, the Navy Unit Commendation, and the Navy 
Commendation Medal with Combat "V," CAPT Addison 
held the Asiatic-Pacific Campaign Medal with three stars 
and the Korean Service Medal with four stars. 

He is survived by his widow. Vera, who lives at 51 12 
Southern Ave., S.E., Washington, D.C. 



on 21 Mar. Born in Philadelphia in 1896, Dr. Behrens 
graduated from the University of Pennsylvania Medical 
School in 1920. Upon graduation he was commissioned 
LT in the Navy Medical Corps. 

Early in his Navy medical career, while serving as 
medical officer aboard the USS Henderson, Dr. Behrens 
participated in the Navy's initial studies of the Kahn 
precipitin test for syphilis. He then served with the 
Marines in Haiti (1929-1932), in the hospital ship USS 
Relief (1937-1938), and practiced general medicine at 
Nav Hosps Pensacola, Newport, and Brooklyn. 

During WWII, Dr. Behrens was a member of the staff 
of the Navy Medical Center, Washington, D.C, where 
he developed the use of 35-millimeter photofluorography, 
for chest surveys and tuberculosis-control techniques. 
In 1947, he founded the Atomic Defense Division of 
BUMED, directing this division until 1951. During 
much of this time he was also CO of the Naval Medical 
Research Institute, Bethesda, Md. 

Dr. Behrens was involved with radiological safety, 
establishment of procedures for clinical use of radio- 
isotopes, and the introduction of photodosimetry. Dur- 
ing WWI I he represented the Navy on the Baruch Com- 
mittee on Physical Medicine, and from 1951 to 1952 



RADM Charles F. Behrens, MC, USN (Ret), a pioneer 
in the field of atomic medicine, died in Annapolis, Md., 




RADM Charles F. Behrens, MC, USN (Ret.), 1896-1974 



56 



U.S. Navy Medicine 



he represented the Office of Naval Research on Project 
East River, a comprehensive study of civil defense. He 
also represented the Navy as councilor to the American 
College of Radiology. 

After his promotion to RADM in 1951 , Dr. Behrens 
was medical officer on the staff of the Eastern Sea 
Frontier in New York City. From 1953 until his retire- 
ment in 1956, he was the Sixth Naval District Medical 
Officer. 

ADM Behrens was the author of numerous papers 
on radiology and internal medicine. In 1949 he wrote 
for, and edited Atomic Medicine, still used as a text- 
book. His second book, After the A-Bomb, written 
after he had witnessed the Eniwetok atomic-bomb tests 
in 1951, addresses the effects of radiation on the people 
of Nagasaki and Hiroshima, and analyzes emergency 
care following atomic blasts. 

Upon his retirement from the Navy (36 years), Dr. 
Behrens joined the staff of the Yater Clinic in Washing- 
ton, D.C., as a radiologist. He was in charge of the 
X-ray Department until his civilian retirement in 1966. 
He also served on the Radiation Protection Committee 
of the Bureau of Standards, and on the Tumor X-ray 
Therapy Board. 

ADM Behrens was a Fellow of the American Council 
of Radiation, a Diplomate of the American Board of 
Radiology, and belonged to the New York Academy of 
Sciences. He is survived by a son, three daughters, 
15 grandchildren and one great-grandchild. 



VADM Joel T. Boone, MC, USN (Ret.), a Congres- 
sional Medal of Honor winner who served as physician 
to three Presidents, died at the National Naval Medical 
Center, Bethesda, Md., on 2 Apr. He was 84 years old. 

VADM Boone was born in St. Clair, Pa., on 29 Aug 
1889. He graduated from the Mercersburg Academy, 
Mercersburg, Pa., in 1909, and in 1913 received his MD 
degree from Hahnemann Medical College in Philadelphia. 
In 1914 he was appointed an assistant surgeon with the 
rank of LTJG in the Naval Reserve. 

Dr. Boone was briefly a member of the staff of Nav 
Hosp Portsmouth, N.H., before beginning a course of 
instruction at the Naval Medical School in Washington, 
D.C. In May 1915 he transferred to the Regular Navy, 
serving at Naval Training Station, Norfolk, Va. Three 
months later he joined the Artillery Battalion, U.S. 
Marine Corps Expeditionary Force, and saw combat 
service ashore in Haiti. 

In Sept 1916 Dr. Boone joined the USS Wyoming, 
serving in that battleship when the United States entered 
WWI in Apr 1917. He then joined the Sixth Regiment 
of Marines, arriving with them in France in early Oct 




VADM Joel T. Boone, MC, USN (Ret.), 1889-1974 




During WWI, Dr, Boone (second from right) served in Europe 
as a LT in the Navy Medical Corps. Many years later he be- 
came the first military medical officer to achieve three-star rank. 



1917. As a Battalion and Regimental Surgeon, and 
later as Assistant Division Surgeon of the Second Army 
Division, American Expeditionary Forces, Dr. Boone 
participated in major battles and campaigns including 
the Defense Sector south of Verdun, Aisne, Aisne- 
Marne, St. Mihiel, Champagne, and Meuse-Argonne. 



Volume 63, May 1974 



57 



After the Armistice on 1 1 Nov 1918, with the Army of 
Occupation, he marched into Germany for duty on the 
Rhine bridgeheads. 

For his services as surgeon in the Boise de Belleau, 
France, in Jun 1918, Dr. Boone was awarded the Dis- 
tinguished Service Cross. He received the Nation's high- 
est military award for bravery — the Congressional 
Medal of Honor — for heroism in action at Vierzy, 
France. The citation for the Medal of Honor reads in 
part: "With absolute disregard for personal safety, ever 
conscious and mindful of the suffering fallen. Surgeon 
Boone, leaving the shelter of a ravine, went forward 
onto the open field where there was no protection, and 
despite the extreme enemy fire of all calibres, through 
a heavy mist of gas, applied dressings and first aid to 
wounded Marines." Dr. Boone was also awarded the 
Silver Star with five Oak Leaf Clusters, and the Purple 
Heart with two Oak Leaf Clusters for services during 
WWI. He received special citations from GEN John J. 
Pershing, USA; MAJGEN John A. Lejeune, USMC; 
MAJGEN Harry Lee, USMC; MAJGEN Omar Bundy, 
USA; and MAJGEN James G. Harbord, USA. 

After his return to the United States in Feb 1919, 
Dr. Boone served at BUMED in Washington, D.C., and 
as Director of the Bureau of Naval Affairs, American 
Red Cross. In May 1922 he became medical officer 











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At the celebration of the 99th anniversary of the Navy Medi- 
cal Department in 1970, VADM Boone (center) renewed his 
friendship with former Navy Surgeons General RADM B.W. 
Hogan (left), and RADM H.L. Pugh (right). 




VADM Boone had a lifelong interest in Navy Medicine. Vis- 
iting BUMED in 1955, several years after his retirement from 
active duty, he received a warm welcome. 



In 1970, VADM Boone joined other medical leaders at the 
annual meeting of the Association of Military Surgeons of the 
United States (AMSUS). From left to right: (front row) 
LTGEN K.E. Pletcher, MC, USAF, Air Force Surgeon General; 
VADM G.M. Davis, MC, USN, Navy Surgeon General; VADM 
Boone; Dr. J.L. Steinfeld, Surgeon General, Public Health Ser- 
vice; COL W.A. Swanker, AUS (Ret.). (Back row) Dr. H. 
Marine Engle, Medical Director, Veterans Administration; BGEN 
F.A. Heimstra, MC, USAF; LTGEN H.B. Jennings, MC, AUS, 
Army Surgeon General; BGEN F.E. Wilson, AUS (Ret.), Exe- 
cutive Director, AMSUS. 



aboard the Presidential yacht, Mayflower, where he 
served until 1929 as physician to Presidents Warren G. 
Harding and Calvin Coolidge. From 1929 to 1933 he 
was Physician to the White House during the adminis- 
tration of President Herbert Hoover. 

In 1933 Dr. Boone completed a general postgraduate 
course at the Naval Medical School and joined the hos- 
pital ship USS Relief as Chief of medicine. From 1935 



58 



U.S. Navy Medicine 



to 1936 he was a member of the staff at Nav Hosp San 
Diego, Calif., subsequently joining the Fleet Marine 
Force in San Diego. He later served as senior med- 
ical officer in the USS Saratoga, from 1938 to 1939. 

After serving briefly as XO and CO of Nav Disp Long 
Beach, Calif., (Jul 1939-Jan 1940}, Dr. Boone joined the 
staff of Commander Base Force, U.S. Fleet, serving in 
the flagship USS Argonne as Force Medical Officer. He 
subsequently became senior medical officer at Naval Air 
Station San Diego (1940-1943), and Medical Officer-in- 
Command of Nav Hosp Seattle, Wash., (1943-1945). 

In Apr 1945 Dr. Boone became Third Fleet Medical 
Officer on the staff of ADM William F. Halsey. He was 
one of three officers selected to liberate Allied prisoners 
of war in Japan before the military occupation of that 
country, and was the Navy Medical Corps representative 
at the Japanese surrender ceremonies conducted aboard 
the USS Missouri in Tokyo Bay on 2 Sep 1945. 

In Jan 1946, after two months of temporary duty at 
BUMED, Dr. Boone was designated the Eleventh Naval 
District Medical Officer, San Diego. Three months later 
he became Inspector of Medical Department Activities, 
Pacific Coast, with additional duty as Medical Officer, 
Western Sea Frontier; he was also Medical Advisor to the 
Federal Coal Mines Administrator, and Director of the 
Medical Survey of the Coal Industry, 1946-1947. 

Early in 1948, Dr. Boone reported to the Secretary of 
Defense for duty as Executive Secretary of the Commit- 
tee on Medical and Hospital Services of the Armed Forces. 
He simultaneously served as Secretary of the Committee 
on Federal Medical Services of the First Commission on 
Organization of the Executive Branch of the Government, 
commonly known as the Hoover Commission. 

On 1 Sep 1949, Dr. Boone became Chief of the Joint 
Plans and Action Division, Office of Medical Services, 
Department of Defense, The following March, he was 
reassigned as General Inspector of Medical Department 
Activities, a position he held until his retirement. As 
General Inspector, ADM Boone was sent by the Chief 
of Naval Operations on a special mission to inspect Navy 
and Marine Corps medical facilities in the Pacific and 
Far East, including the fighting front of Korea. His 




subsequent recommendation that helicopter landing plat- 
forms be built on hospital ships to speed evacuation 
of the wounded, helped save the lives of hundreds of 
combat troops fighting in Korea, and later in Vietnam. 

Dr. Boone's name was placed upon the Permanent 
Physical Disability Retired List on 1 Dec 1950. Fol- 
lowing his retirement from active military duty, he 
served four years as Chief Medical Director of the Vet- 
erans Administration. 

VADM Boone was the most highly decorated physi- 
cian in the history of Navy medicine. In addition to 
the Medal of Honor, Distinguished Service Cross, Silver 
Star, and two Purple Heart Medals, he held the Haitian 
Campaign Medal, Marine Corps Expeditionary Medal, 
WWI Victory Medal with six battle stars, and Army of 
Occupation'Medal (Germany) for service prior to and 
during WWI. For service in WWII, he received a letter 
of commendation from the then Secretary of the Navy, 
James Forrestal, and was awarded the Secretary of the 
Navy's Commendation Medal. His other awards include: 
Bronze Star Medal with Combat "V," American De- 
fense Service Medal with Fleet Clasp, Asiatic-Pacific 
Campaign Medal with two bronze stars, American Cam- 
paign Medal, WWII Victory Medal, Navy Occupation Med- 
al (Japan), Korean Service Medal, United Nations Service 
Medal, National Defense Service Medal, and Republic of 
Korea Presidential Unit Citation Badge. TheFrench Gov- 
ernment bestowed upon him the Officer of the Le- 
gion of Honor award, Croix de Guerre with two palms. 
Order of the Fourragere (three awards), and the Gold 
Medal of Honor. The War Cross with Diploma of Italy 
was bestowed by that Government on Admiral Boone. 

VADM Boone belonged to many medical, military, 
and academic organizations. He was a former President 
of the Association of Military Surgeons of the United 
States, and had represented the Navy as a member of 
the House of Delegates of the American Medical Asso- 
ciation. He was a Fellow of the American College of 
Surgeons, American College of Physicians, International 
College of Surgeons, American College of Chest Physi- 
cians, and the AMA. 

The Joel T. Boone Hall at Mercersburg Academy, 
dedicated 13 Oct 1962, was named in his honor. On 
15 Mar 1972, the Joel T. Boone Clinic was dedicated 
at the Naval Amphibious Base, Little Creek, Va. (U.S. 
Navy Medicine 60(4): 13-1 6, Oct 1972) 

VADM Boone is survived by his wife, Helen, who 
resides at The Westchester, 3900 Cathedral Ave., N.W., 
Washington, D.C. 



The ADM Joel T. Boone Clinic was dedicated at US Naval 
Amphibious Base, Little Creek, Va., on 15 Mar 1972. 



RADM Dwight Dickinson, Jr., MC, USN (Ret.), a 
specialist in neuropsychiatry whose career in Navy 



Volume 63, May 1974 



59 



medicine spanned 37 years, died 17 Mar at the National 
Naval Medical Center, Bethesda, Md. He was 87 years old. 

Dr. Dickinson was born in Jamestown, N.Y., on 2 
Aug 1887. He was the son of Commodore Dwight 
Dickinson, MC, USN, who himself was a Navy physician 
for 40 years. After completing his undergraduate train- 
ing at the Massachusetts Institute of Technology, RADM 
Dickinson attended Georgetown University School of 
Medicine, Washington, D.C., receiving his MD degree in 
1909. In 1911 he was appointed Acting Assistant Sur- 
geon in the U.S. Navy. 

During WWI Dr. Dickinson was a battalion surgeon 
with the Second Battalion, Fifth Marine Regiment, 4th 
Brigade, American Expeditionary Forces. He participated 
in the St. Mihiel, Blanc Mont, Champagne, and Meuse- 
Argonne offensives in France, earning the Navy Cross 
and Distinguished Service Cross for extraordinary hero- 
ism in action near St. Etienne, and the Silver Star for 
services at Mont Blanc Ridge. He also accompanied the 
Army of Occupation to Germany. 

In the early 1920s, during President Warren G. Hard- 
ing's administration, Dr. Dickinson served aboard the 
Presidential yacht, the Mayflower. He subsequently 
served again as battalion surgeon with the Marine Corps 
during the Second Nicaraguan Campaign (1926-1933), 
operating in the mountains of northern Nicaragua against 
General Augusto Sandino and his revolutionary forces. 

Dr. Dickinson also served in the USS Ogala, USS 
Denebola, and USS Bainbridge. He was a member of 




the staff at BUM ED, and at the Navy Yard in Washing- 
ton, D.C.; at the Fleet Air Base in Pearl Harbor, Hawaii; 
and Nav Hosps Washington, Philadelphia, and Newport. 
In 1945 he was named to the BUMED Naval Examining 
and Retiring Board, a position he held until his retire- 
ment. Dr. Dickinson's name was placed on the Retired 
List on 1 Sep 1948 in the honorary rank of RADM. 

RADM Dickinson was decorated with the Croix de 
Guerre by the Government of France, and with the Me- 
dal lo de Merito by the Government of Nicaragua. He al- 
so held the WWI Victory Medal with three battle clasps, 
Army of Occupation Medal (Germany), Second Nicara- 
guan Campaign Medal, American Defense Service Medal, 
American Campaign Medal, and WWII Victory Medal. 

Admiral Dickinson is survived by: his widow, 
Elizabeth, who resides at 2212 R St., N.W., Washing- 
ton, D.C.; a son, John; a daughter, Anne; a sister; and 
two grandchildren. 



RADM Dwight Dickinson, Jr., MC, USN (Ret.l, 1887-1974. 



CAPT Charles F. Lynch, DC, USNR (Ret.), a veteran 
of 29 years of Naval service, died on 9 Jan in New 
Orleans, La. Born in Schenectady, N.Y., on 1 Oct 
1905„he graduated from Tufts College and received 
his D.M.D. degree from Harvard University. 

Dr. Lynch was commissioned a LTJG in Jul 1930, 
and began his Navy career as assistant dental officer at 
the U.S. Naval Academy, Annapolis, Md. He served as 
dental officer in the USS Chester from Jan 1932 to Jun 
1934, after which he returned to the Naval Academy 
as assistant dental officer. He became dental officer in 
the USS Savannah in 1938, and at the Navy Yard, 
Washington, D.C., in 1940. 

From 1941 to 1945, Dr. Lynch served in an admin- 
istrative capacity at the Bureau of Medicine and Surgery, 
Washington, D.C. He became Fleet Dental Officer for 
CINCPACFLT and COMSERVPAC in Feb 1945, and 
was promoted to the rank of CAPT one month later. 
CAPT Lynch attended the Naval War College from 
1947 to 1948, after which he served one year in the 
Naval Medical Materiel Office. For five years (1949- 
1954) he was a member of the staff of the Planning 
Division of the Bureau of Medicine and Surgery, with 
additional duty at OPNAV and the Office of Naval 
Research. From 1954 until his retirement in 1959, he 
was Commanding Officer of NAVDENCLINIC, Camp 
Pendleton, Calif. 

CAPT Lynch held the American Defense Service 
Medal with Fleet clasp, Asiatic-Pacific Campaign Medal, 
World War II Victory Medal, and National Defense Ser- 
vice Medal. 

He is survived by his widow, Alice, who resides at 
6550 Oakland Drive, New Orleans, La.^ 



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LAPFUL OF LOVE.— LTJG Mary Walters, IMC, USNR 
rocks two Colombian children to sleep in the hospital ship USS 
Sanctuary. LT Walters was a member of the Navy health care 
team that made a month-long goodwill stop in Colombia last 
year as part of Project HANDCLASP. The two children under- 
went surgery aboard the Sanctuary. 



U.S. NAVY MEDICINE